When pica takes a step too far: small bowel obstruction due to ingested shoe insoles, a case report and review of literature

Pica, the compulsive ingestion of nonfood items, is a condition that can lead to life-threatening complications, including small bowel obstruction (SBO). This condition is particularly challenging to diagnose in individuals with cognitive impairments and limited verbal communication. We present a case of SBO secondary to shoe insole ingestion in a patient with autism and pica, highlighting the diagnostic and therapeutic challenges encountered. This case underscores the importance of a high index of suspicion for SBO in patients with pica and cognitive impairments. Radiologic imaging and endoscopic evaluation can be critical in the diagnosis, and surgical intervention may be necessary for definitive management. A literature review of similar cases emphasizes the need for early recognition and intervention to reduce morbidity and mortality in this population. SBO secondary to pica remains a diagnostic challenge in nonverbal patients. Timely imaging, multidisciplinary management, and individualized therapeutic approaches are essential for optimal patient outcomes.