Background and Aims We present a case of a severely autistic 14 year old boy referred to paediatric outpatients with a 1 year history of pica and early morning retching. This was initially considered behavioural in origin. Review of previous Abdominal X-ray (Image 1) revealed a gastric bezoar; at surgery this had resolved but duodenal adhesions were found and divided with recovery of symptoms. Distinguishing which symptoms are behavioural in origin and which are organic can prove a diagnostic conundrum in learning disabled patients. We aim to provide guidance for rational investigation.
Methods We present a literature review on learning disabled children presenting with unexplained symptoms.
Results Autistic children have an increased tendency to develop pica, and gastric bezoar causing obstruction is well described. Learning disabled children can also present with a range of gastrointestinal problems including diarrhoea, constipation and vomiting which may also be secondary to pica. Behavioural symptoms may be difficult to distinguish from gastrointestinal symptoms for example gastro-oesophageal reflux.
Conclusions We propose a collaborative approach between general and community paediatricians and present proposed guidance for investigation of symptoms.