Tendency to Ingest Foreign Bodies in Mentally Retarded Patients: A Case with Ileal Perforation Caused by the Ingestion of a Teaspoon

Abstract

Introduction. Unintentional foreign body ingestion commonly occurs accidentally in children aged between 3 months and 6 years and at advanced ages or results from psychiatric disorders such as hallucination in patients with mental retardation. Most of the ingested foreign bodies are naturally discharged from the body but some of them may require surgical intervention. Presentation of Case. A 29-year-old mentally retarded female patient was admitted to the emergency service with a two-day history of abdominal pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, defense, and rebound on palpation. Radiological examination revealed diffuse air-fluid levels and a radiopaque impression of a metal object in the right upper quadrant. The metal teaspoon causing ileal perforation was extracted by emergency laparotomy. On postoperative day 7, the patient was uneventfully discharged following a psychiatric consultation. Discussion. Foreign body ingestion can occur intentionally in children at developing ages and old-age patients, or adults and prisoners, whereas it may occur unintentionally in patients with mental retardation due to hallucination. However, repeated foreign body ingestion is very rare in individuals other than mentally retarded patients. Conclusion. Mentally retarded patients should be kept under close surveillance by surgeons and psychiatrists due to their tendency to ingest foreign bodies.

The Foreign Body Ingestion which is an important cause of mortality and morbidity

“…Yildiz et al [38] reported ileal perforation in a patient with mental retardation who had ingested a teaspoon. Gastrointestinal tract complications are also often seen in psychiatric patients as the result of swallowing foreign bodies such as screws, nails, scrap metal, lighters, pegs, and coins.…”

Adult With Multiple Ingested Foreign Bodies Within the Large Bowel

“…Foreign body (FB) ingestion is among the commonest emergencies in gastroenterology-endoscopy; this is often involuntary in adults and may be voluntary in psychiatric patients, drug abusers, and elderly and children. [1][2][3][4][5][6][7][8][9][10][11][12][13] The estimated male to female ratio of this phenomenon is 1.5:1, and the FBs differ among the age groups. 1,2,10 The BFs pass beyond the esophagus and resolve spontaneously in up to 90% of cases; the others impact on some segment of the gastrointestinal tract and require interventions.…”

“…1,2,10 The BFs pass beyond the esophagus and resolve spontaneously in up to 90% of cases; the others impact on some segment of the gastrointestinal tract and require interventions. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, the morbidity and mortality associated with impacted FBs is significant. 2,4,7,11 The commonest sites of impaction are: upper, middle and lower esophagus; stomach; angle of Treitz; ileocecal valve, and appendix.…”

“…2,4,7,11 The commonest sites of impaction are: upper, middle and lower esophagus; stomach; angle of Treitz; ileocecal valve, and appendix. 1,2,4,[4][5][6][7][8][10][11][12][13] Main clinical manifestations are: odynophagia, dysphagia, globus pharynges, vomiting, and abdominal pain. 1,2,4,7,8,13 Abdominal radiograph, sonography, and computed tomography have utmost importance to detect the presence, the nature, and the exact location of gastrointestinal FBs.…”

“…1,2,4,[4][5][6][7][8][10][11][12][13] Main clinical manifestations are: odynophagia, dysphagia, globus pharynges, vomiting, and abdominal pain. 1,2,4,7,8,13 Abdominal radiograph, sonography, and computed tomography have utmost importance to detect the presence, the nature, and the exact location of gastrointestinal FBs. [6][7][8][9]11,13 Worthy of note, impaction of ingested FBs on the large bowel is scarcely described, and colonoscopy or open surgery are performed to manage their consequences.…”