Case report 'ACUPHAGIA' - An adult Nigerian who ingested 497 sharp metallic objects

'Acuphagia', the compulsive ingestion of sharp objects is a rare form of Pica A case of 'Acuphagia' is reported in an adult male Nigerian and the possible reasons for this abnormal behaviour explored. A 22 year old man presented with a six month history of persistent vomiting after meals, cough, weakness, inability to walk and swelling of the legs and face. He was found to be pale, with generalized edema and malnourished. Plain abdominal X-ray showed radio-opaque shadows of metallic objects in the upper abdomen. He was transfused with blood and prepared for surgery. At Laparatomy, 497 metallic objects were found in the stomach without any perforation. He did well subsequently and was referred for psychiatric evaluation. This was rather an enigmatic case to us as we could not identify any reason why this young adult swallowed such a large amount of metallic objects. The patient vehemently denied swallowing or ingesting these objects, and none of his relations or neighbors saw him ingest these objects at any time. In our part of the world where magical arts (juju) is widely practiced and believed, this was the explanation most of his relations adduced for this illness. However, we are of the opinion that a combination of factors like Poverty, Isolation, Neglect and loneliness may have triggered such a bizarre behaviour.