Intentional Foreign Body Ingestions: A Complex, Recurrent and Costly Issue

Abstract

Patient: Male, 23-year-old Final Diagnosis: Foreign body ingestion Symptoms: Abdominal pain • nausea Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Psychiatry • Toxicology Objective: Rare disease Background: Recurrent intentional foreign body (RIFB) ingestion is a complex and costly issue among patients in prison and those with psychiatric disorders. Risk factors for RIFB ingestion include male sex, incarceration, and the presence of a psychiatric disorder. Most patients can be managed with observation and endoscopy. Surgery is indicated in cases involving perforation or obstruction. The literature on preventative strategies for RIFB ingestion is scarce. Case Report: A 23-year-old man required 6 admissions in 1 calendar year for intentional foreign body ingestions. The patient was living in prison and had a history of bipolar I disorder, schizophrenia, and borderline personality disorder. He underwent 9 endoscopic procedures that retrieved a total of 64 objects. The primary imaging modalities were abdominal X-ray and abdominopelvic contrast-enhanced computed tomography scan. The patient was managed with endoscopy and, in 2 cases, with observation alone. Serial abdominal examinations and abdominal films were used to monitor the progress of foreign bodies that were difficult to retrieve. A bowel regimen with polyethylene glycol facilitated the passage of the objects. The patient never required surgical intervention. The mean length of stay was 4.17 days. The recurrent ingestions may have been related to compulsions and family stress. Conclusions: Interdisciplinary collaboration is paramount in formulating effective treatment plans and limiting recurrence. Proposed strategies to prevent RIFB ingestion include the removal of ingestible objects from the environment, specialized prison units for close monitoring, early psychiatric intervention with appropriate pharmacologic/ behavioral therapy, and limiting hospital admissions to prevent secondary gain. Further studies are needed to determine the most effective approach to manage and prevent RIFB ingestion.

Patient characteristics, outcomes and hospital-level healthcare costs of foreign body ingestion from an Australian, non-prison referral centre

“…7 Major international endoscopy societies, including the European Society for Gastrointestinal Endoscopy (ESGE) and the American Society for Gastrointestinal Endoscopy (ASGE), have published standards of practice guidelines for the manageent of FBI, 8 9 guided by factors such as object location, size, sharpness, caustic potential and magnetism. Management and adherence to local guidelines were previously well described in case reports 10 and case series. 11 The more recent retrospective observational study mentioned above also correlates the centre's management of FBI with ESGE guidelines including median time to extraction and use of protective devices.…”

Intentional Ingestion of Foreign Bodies: A Physician’s Agony

“…Selecting the appropriate diagnostic tool to locate the foreign body depends on the time of presentation to the emergency department, the type of substance swallowed, and the severity of symptoms [4]. The imaging modality most commonly employed for initial screening is X-ray due to its convenience and accuracy [2,4].…”

“…Surgical intervention is rare but reserved when the previously mentioned management strategies fail, that is, if the object is >6-7 cm in size, past the ligament of Treitz, and has not progressed in three days, or when complications such as perforations occur [15][16][17][18]. Factors that increase the risk of surgery include elevated differential blood count, previous surgeries, and a history of repeated ingestion [2,19].…”

“…Despite its increasing occurrence, there are few studies that highlight the need for a multispecialty approach to treatment [ 1 ]. Recurrent foreign body ingestion is most commonly seen in children, adults with psychiatric illnesses such as personality disorders, and prisoners [ 2 ]. The main difference is that in adults, ingestion of these objects is almost always intentional, while it is accidental in children [ 3 ].…”

“…Serious complications of foreign body ingestion include esophageal occlusion, bowel obstruction, perforation, necrosis, and fistula formation [ 4 ]. The most commonly used imaging modality in these cases is X-ray due to its accuracy in identifying radiopaque objects [ 2 , 4 ]. The majority of clinically stable patients will pass the object within four to five days, while for patients with complications, endoscopy and surgical intervention are required to retrieve the object [ 4 ].…”