Repeated Intentional Swallowing of Foreign Objects by an Adolescent Girl (Case Report)

Abstract

Introduction: Intentional swallowing of foreign objects is a relatively rare psychopathological behavior. Adolescents and young adults may carry out this act to hurt themselves or even suicide. Often, most reports related to deliberate swallowing are typically either surgical or gastrointestinal and rarely are found in psychiatric articles; more often, the swallowed foreign objects (80 - 90%) are disposed of spontaneously, and 10 - 20% of them require endoscopy for more study and less than 1% of them need surgery to be removed or its complications. Case Presentation: The presented patient is a 17-year-old girl admitted to the psychosomatic ward of Afzalipour Hospital due to intentional poisoning. During the year before her admission, on three separate occasions, she detached the knife blade from its haft and swallowed it. She underwent laparotomy twice, one time for sigmoid tearing and damage to the left Ovary, to remove the knife and regeneration of the left ovary and sigmoid, and another time to remove the knife in order not to cause damage to her intestines. To our knowledge, this is the first reported case in the world in which an ovary has been damaged. Further investigation into her background shows some extent of privation due to her family's long-term economic problems and instability; moreover, sexual and physical abuse was also confirmed. The patient was prescribed clozapine, which decreased her suicidal behavior and attempts noticeably. Conclusions: Swallowing foreign bodies in this patient is interpreted as both self-punishment and punishing others (those who thought they were hurt or may be blamed for their despair or rejection). Intentional swallowing of foreign objects behavior is more resistant than other self-harming activities and may have a worse prognosis. Swallowing foreign objects requires a sophisticated process that, if not correctly managed, may result in serious complications; therefore, appropriate psychiatric counseling and supportive treatment are necessary for these patients. Specific to this patient eliminating the effects of suicide and reaching medical stability with a short admission was necessary. Her suicidal behavior and attempts decreased significantly after starting clozapine treatment. Therefore, clozapine treatment is recommended for patients with suicidal behavior and self-harm.