A man with intentional ingestion in a suicide attempt.

Abstract

A 31-year-old man with a history of borderline personality disorder and multiple foreign bodies ingestion presented to the emergency department with generalized abdominal pain and suicidal thoughts. Vital signs showed a temperature of 38.3°C (101°F) with a pulse rate of 112 beats/min and blood pressure of 138/72 mm Hg. Physical examination revealed general abdominal pain with no guarding. Laboratory examination indicated a white blood cell (WBC) count of 16,760/μL and a C-reactive protein level of 201.76 mg/dL. The radiography for the chest and abdomen showed multiple cylindrical batteries, 15 batteries in the epigastric and left hypochondriac region (Figures 1 and 2), 4 batteries in the right lumbar region, and 1 battery in the hypogastrium (Figures 3 and 4). Deliberate foreign body ingestion is commonly observed in patients with borderline personality disorder and other mental disorders. The high number of batteries detected by radiography in different places of the gastrointestinal system is a risk for bowel obstruction, corrosive injuries,1, 2 peritonitis, perforation, and death. Guidelines indicate that cylindrical batteries that remain in the stomach for over 48 hours after ingestion should be removed,3 but in the case of suspected clinical complications, an emergency surgery should be planned. Because of the suspected corrosive injuries of the batteries, an exploratory laparotomy was performed. A total of 20 cylindrical AA batteries were removed with no visual bowel injuries.