CME Article

Agitation and Decreased Oral Intake in an Adolescent with Autism

Prita H. Mohanty, MD; Megan Gabel, MD

  • Pediatric Annals
  • June 2012 - Volume 41 · Issue 6: 1-3
  • DOI: 10.3928/00904481-20120525-07
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Abstract

CME Educational Objectives

  1. Understand that in developmentally delayed, and autistic children, gastrointestinal conditions can present typically or atypically as non-gastrointestinal manifestations, including behavioral changes and problem behaviors.

  2. Maintain an index of suspicion for bezoars in cases of bowel obstruction in these children.

  3. Review the presentation and evaluation of children with bezoars.

A 14-year-old boy with autism was referred to the emergency department because of a 3-week history of decreasing oral intake and a 20-lb unintentional weight loss. History of chewing on nonfood items such as erasers, rubber items and toilet plungers was elicited.

There was no history of fever, vomiting, diarrhea, or constipation. There were no sick contacts and no significant recent travel.

His past surgical history and family history were unremarkable. Of note on social history, this young man was living with his grandmother and siblings. His home environment was disorganized and chaotic.

When examined, he was nonverbal, withdrawn, and agitated. His weight was 90 kg (> 95th percentile), height was 173 cm (75th percentile), and body mass index was 30 kg/m2. His vital signs were normal. The abdomen was soft and not tender.

Plain abdominal radiographs showed signs of partial intestinal obstruction with intraintestinal foreign bodies.

Abdominal computed tomography showed focally dilated loops of small bowel with intraluminal foreign bodies, possibly bezoars (Figure 1). Radio-opaque densities were also noted in the pyloric region and transverse colon.

AUTHORS

Prita H. Mohanty, MD is a Fellow, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY. Megan Gabel, MD, is Assistant Professor, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY.

Disclosure: Drs. Mohanty and Gabel have disclosed no relevant financial relationships.

Address correspondence to: Prita H. Mohanty, MD; 601 Elmwood Avenue, Box 667, Rochester, NY 14642; fax: 585-275-0707; email: Prita_Mohanty@urmc.rochester.edu

doi: 10.3928/00904481-20120525-07

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