EGS P21 Hard to swallow, hard to treat

Abstract

Abstract Background Deliberate foreign body ingestion (DFBI) presents unique medical, surgical, and ethical challenges. Often, patients with psychiatric conditions repeatedly ingest foreign bodies, leading to frequent emergency department visits. Standardised management guidelines are lacking, resulting in high hospitalisation rates, interventions, and complications. This study focuses on recent DFBI cases at our institution, providing insights into this complex condition and holistic management. Methods Patients admitted by the surgical team at Croydon University Hospital between 2017 and 2023 with DFBI were included. Data on demographics, clinical presentation, investigations, and management were collected. Complications, hospitalisations, interventions, and cost analysis were recorded. Results Eight patients presented a total of 52 times. The incidence of DFBI increased over time. Swallowed objects included knives, needles, magnets, glass, batteries, pencils, gloves, lighters, and screws. Each patient underwent an average of 21 X-rays, 2 CT scans, and 3 OGDs. Eleven laparotomies and 1 laparoscopy were performed. The average length of stay was 44.5 days. Complications included pulmonary embolism, pneumonia, enterotomy, hernia, and infection. The average cost per patient was £30,866.25. Conclusions DFBI poses a significant burden on healthcare systems. Patients face radiation exposure and repeated invasive interventions, necessitating a comprehensive approach. Understanding DFBI from a biopsychosocial and ethical perspective is crucial. A multidisciplinary team should be involved early, with clear goals. Further research is needed for optimal management pathways.