Recurrent Voluntary Ingestion of Alkaline Batteries by a Psychiatric Patient

Abstract

Introduction: Foreign body ingestion occurs in approximately 100,000 cases per year, with 80% of them occurring in children. Most foreign bodies that reach the gastrointestinal tract pass spontaneously, with 10-20% requiring endoscopic removal and less than 1% needing surgical intervention. Common foreign bodies include coins, button batteries, food impaction, magnets, and paper clips and pins. Here we present a case of a young adult admitted multiple times after ingestion of two AA batteries secondary to suicidal attempt.Figure: Colonoscopy demonstrating friable pseudomembranous colitis. Friable mucosa was noted throughout the colon up to the ascending colon.Figure: Using LowerPrep by OpenBiome, 250cc of FMT was injected continuously during withdrawal of the colonoscope.Case Presentation: 33 year old female with past medical history of bipolar disorder and schizoaffective schizophrenia presented to the hospital after ingesting two AA batteries in an attempt of suicide. This was the tenth admission with similar presentation of ingestion of alkaline batteries. Physical examination on this admission was within normal limits and the patient was in no acute distress, similar to past encounters. Initial abdominal x-ray revealed two batteries over the left upper and mid abdomen with no evidence of pneumoperitoneum or intestinal obstruction (see image 1). Gastroenterology was consulted and esophagogastroduodenoscopy (EGD) was preformed, however no batteries were seen in the stomach up until the second portion of the duodenum. There were no masses or ulcers, and the esophageal mucosa was normal with few gastric erosions in the body of the stomach. Prior EGD has revealed positive presence of batteries in the stomach as well as small bowel (see image 2). Due to inability to visual the batteries on this admission, no further management was performed - as it was believed the foreign objects likely passed into the distal small bowel and would likely pass with defecation. One day later, repeat abdominal x-ray no longer revealed batteries or any other foreign bodies in the abdomen, with no signs of obstruction or significant ileus. The patient was hemodynamically stable and doing well on the floor. She was released to a psychiatric facility thereafter. Conclusion: Foreign body ingestion, in this case two AA batteries, can be a life threatening incident that must be taken seriously and urgently managed to ensure optimal quality of life.Figure. 2: double AA batteries over the left upper and mid abdomen on most recent admission.Figure: one AA and one AAA retrieved from stomach.