Deliberate Foreign Body Ingestion Research Articles

DELIBERATE INGESTION OF FOREIGN BODIES: A SYSTEMATIC REVIEW

ABSTRACT: Introduction and objective: Accidents with foreign bodies of all types have been described in most parts of the body. The most common places are the natural head and neck cavities. The objective of this study is to know the situation of deliberate ingestion of foreign bodies. Method: We conducted a search in PubMed, Cochrane, Scopus, Wos and Scielo, selecting those articles in which the existence of intentional ingestion of foreign bodies was mentioned. Two ways of research were used using the terms “deliberate” and “intentional” AND “foreign body” in the maximum time suggested by the PubMed platform. Results: With the word “deliberate”, 14 articles were found from 1990 to 2021 and with the word “intentional”, 25 articles were found in the period from 1984 to 2021. All other research sources had zero articles. The sum of these articles was 39. A screening was performed and only clinical cases were selected and we obtained 12 articles using the word “deliberate” and 9 using the word “intentional”. Of these, 1 article was excluded because it is not in the selected language (English, Portuguese or Spanish), leaving a sample of 11 articles. Of these, 2 were excluded because they did not have an abstract, leaving 9 articles and all of them were excluded because they did not comply with the inclusion criteria (in non-prisoner individuals and without mental disorders). Conclusions: Accidents with foreign bodies are common in ENT clinical practice, however, deliberated ingestion is less frequent. The deliberate ingestion of foreign bodies appears in groups at risk, such as prisoners and the mentally ill with the aim of drawing attention or getting out of prisons in an attempt to escape.

Multiple sewing needles ingestion: a case report and review of the literatures

Sharp foreign body ingestion and management pose a great challenge to the surgeon. Majority of ingested foreign bodies pass through the gastrointestinal tract spontaneously. Organ perforations and possible migration should be kept in mind in patients with abdominal pain when the progress of the foreign body through the gastrointestinal tract cannot be ascertained by radiography. A 26-year-old male psychiatric patient presented with epigastric pain following ingestion of 18 sewing needles. His abdominal radiograph showed multiple metallic foreign bodies in the abdominal cavity consistent with the shape of sewing needles. He passed some needles spontaneously while the others which were retained were removed via a laparotomy after a successful pre-operative localization. Post-operative period was uneventful. A deliberate ingestion of foreign bodies should be kept in mind in patients with psychiatric disorders and mental retardation when they present with abdominal pain to the emergency department. An initial wait and see line of management may be instituted with the hope of spontaneous passage which can be monitored via radiological means. However, if the objects fail to pass naturally, surgery is indicated. Sharp foreign bodies which fail to pass spontaneously should be surgically removed after a proper localization since they could cause life threatening complications.

“Fighting for the Last Gasp”—Severe Borderline Personality Disorder and Posttraumatic Stress Disorder, Chronic Deliberate Ingestion of Foreign Bodies, and Palliative Struggles in Intensive Care

Repeated deliberate ingestion of foreign bodies can have tragic long-term consequences. We report the case of a young woman with borderline personality disorder and chronic posttraumatic stress disorder, whose chronic repeated ingestion of razor blades and batteries eventually resulted in severe medical complications. We focus on the involvement of the consultation-liaison psychiatry team as part of her multidisciplinary care, predominantly in the intensive care environment. Her care posed extensive challenges due to the retraumatizing effects of the intensive care environment and the measures required to provide life-sustaining care when the young woman was emotionally dysregulated. Strategies used to address team dynamics and "compassion fatigue" are discussed, including some pertinent relevant literature that was used as educational material for staff to develop a better understanding of the confronting and apparently self-defeating antitherapeutic behavior she frequently displayed. The consultation-liaison psychiatry team has a significant role to play in such situations, carefully balancing patient advocacy roles while simultaneously supporting staff who may be vicariously traumatized by the substantial emotional challenges of providing care in these circumstances.

(22) Multi-Disciplinary Approach to Managing Deliberate Foreign Body Ingestion on the Medical Floor

(22) Multi-Disciplinary Approach to Managing Deliberate Foreign Body Ingestion on the Medical Floor

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

A man with intentional ingestion in a suicide attempt.

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.

S608 Intentional Foreign Body Ingestion and Post-Traumatic Stress Disorder: A Review of Case Reports, Endoscopic Outcomes, and Interdisciplinary Management

Introduction: This study endeavors to fill the knowledge gap concerning deliberate foreign body ingestion (DFBI) in relation to psychiatric disorders. It concentrates on DFBI among adults diagnosed with post-traumatic stress disorder (PTSD) regarding types of foreign body (FB) ingested, motivation for DFBI, and outcomes of endoscopic FB retrieval. Methods: A review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: 261785) was performed, searching electronic bibliographic databases from January 1, 2015 to June 1, 2021. Case reports written in English detailing endoscopic findings of DFBI among adults (≥18 years) were included. Articles without the number and type of items deliberately ingested were excluded. Eligible studies were assessed using the Joanna Briggs Institute critical appraisal tool. Results: Of the 55 included case reports, the 5 PTSD patients (9%) were older (μ age: 41.60 vs 34.16 years, p=0.15), less predominantly male (M:F Ratio: 1.5:1 vs 1.75:1, p=0.56), reported less abdominal pain presentations (40% vs 46%, p=0.40), and had a higher average of concomitant psychiatric conditions (μ=3 vs 1, p< 0.01), than the 55 non-PTSD patients. PTSD patients ingested more items (μ=34.8 vs 7.74, p< 0.05); specifically more large paper (μ=0.2 vs 0, p< 0.01), large wood (μ=2.8 vs 0.04, p< 0.01), small metal (μ=14 vs 0.34, p< 0.01), sharps/blades (μ=12.4 vs 1.32, p< 0.05), batteries (μ=5.4 vs 0.48, p< 0.01), than those without PTSD. The primary reasons for ingestion for both PTSD and non-PTSD patients included prior history of repeated DFBI [n=3 (60%) vs n=18 (36%), p=0.15, respectively] and suicidality (n=1 (20%) vs n=9 (18%), p=0.45, respectively]. PTSD patients had a higher average success rate of endoscopic removal (without need for post-endoscopic surgery) than non-PTSD patients (μ=1 vs 0.66, p=0.12), as well as reported use of interdisciplinary management (μ=1 vs 0.82, p=0.31). Though there was little difference in mean number of total interdisciplinary referrals made (μ=1.8 vs 1.3, p=0.28), the most common referrals were to psychiatry (47%) and gastroenterology (33%). Conclusion: In DFBI cases of patients with PTSD, a high index of suspicion is required with regards to presentation, type of FB ingested, and reason for ingestion. Further research is needed to determine if PTSD or interdisciplinary management are factors for successful endoscopic FB removal and surgery should endoscopy fail.

S607 Endoscopic and Surgical Management of Deliberate Foreign Body Ingestion in Patients With Personality Disorder: A Review of Case Reports

S607 Endoscopic and Surgical Management of Deliberate Foreign Body Ingestion in Patients With Personality Disorder: A Review of Case Reports

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum. Keywords: foreign bodies; Nepal; shaman.

Deliberate ingestion of foreign bodies as a form of self-harm among inpatients within forensic mental health and intellectual disability services

ABSTRACTDeliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It is associated with serious physical complications, including bowel obstruction, perforation and haemorrhage. Episodes of deliberate foreign body ingestion were identified retrospectively from 5417 incident records from two inpatient forensic services (one mental health and one intellectual disability) over a one year timeframe, using related search terms. Rates were compared according to gender, diagnosis and level of security. Incidents of deliberate foreign body ingestion were found to occur on average every 2.7 days across the study population, with 133 incidents recorded over a one year period, accounted for by 27 patients. Women and patients in lower levels of security were significantly more likely to engage in deliberate foreign body ingestion. Staff responses to this behaviour were highly variable. Deliberate foreign body ingestion occurs frequently within inpatient forensic services, and can have significantly detrimental physical implications for affected patients. Further research should investigate the psychiatric and intellectual disability profile of such individuals in further detail, as well as exploring patient narratives; both of which will help inform development of treatment strategies.

Deliberate Foreign Body Ingestion

Deliberate Foreign Body Ingestion

Foreign Body Ingestion in a Patient with Psychiatric Illness

Background: There are many challenges in treating patients who engage in deliberate foreign-body ingestion as a method of self-harm. Whereas other forms of mutilation may be dangerous to patients and distressing to their treaters, foreign-body ingestion carries a sense of insidiousness in the lack of outward evidence that harm has been done and in the latent risk of further injury even after a diagnosis has been made. Case Report: Here we report a case of foreign body ingestion in a patient with psychiatric illness and discuss what is known about deliberate foreign-body ingestion and some of the clinical problems they pose, with a focus on medical literature regarding the diagnosis and treatment of such cases. Conclusion: Timely counseling and psychiatric support is essential for foreign body ingestions.

Deliberate Foreign Body Ingestion and Hopefulness Across Clinical Settings: An Under-Appreciated, but Significant, Non-Suicidal Self-Injury

Deliberate Foreign Body Ingestion and Hopefulness Across Clinical Settings: An Under-Appreciated, but Significant, Non-Suicidal Self-Injury

Deliberate Ingestion of Stones Causing a Diagnostic Dilemma : A Personal Experience

Deliberate ingestion of foreign bodies is not a new subject especially in our society where such patients are neglected and their problems are rarely investigated properly. These kinds of problems usually have a compulsive driven and complicated elements involved which are very refractory to treatment and are often repetitive. Such a habit is mostly seen in children of very tender age but the situation is more worrisome when you come across adults who are otherwise considered normal but are found to have a deliberate compulsion to ingest funny things like papers, stones, jewelry and other injurious agents which can lead to life threatening complications. A very interesting case of a young girl is presented here which will certainly be beneficial to the surgeons as well as practitioners.

Disordered Eating Behavior in a Schizophrenic Patient: a Case of Pica.

Introduction Pica is an eating disorder characterized by eating of nonnutritive materials. It has been reported in different population, from certain ethnic groups, children, pregnant woman or organic disorders (eg. mineral deficiency) to psychiatric patients, including psychotic. Objectives To describe a patient who ingest nonfood substances and its relationship with delusions. Methods X is a 26 year-old male with Paranoid Schizophrenia who came into the psychiatric emergency service because of an acute exacerbation of his mental illness, presenting auditory hallucinations and delusional mysticism. Draws our attention the presence of an aberrant eating behavior ingesting animals, lime, earth and leaves. The patient was hospitalized in the Impatient Psychiatric Unit for examination and treatment. Results Several medical tests were performed and the only finding was an idiopathic eosinophilia, considered secondary to pica. He referred that the ingested items provided him from energy and better sight, as an explanation for his eating behavior. No suicidal ideation was objectified. Neuroleptic treatment was prescribed and behavioral and psychotic symptoms improved progressively. Conclusions The etiology of pica is unknown. Schizophrenic motivation for deliberate foreign body ingestion is a poorly understood phenomenon. In the case presented, the ingestions seems to be secondary to delusional beliefs that these objects contains properties that the patient lacks, not obeying to suicidal behavior and objectifying parallel remission of the pica and delusional activity. Further research is needed to clarify the etiology and mechanisms of this disorder, as it can lead to serious medical consequences (eg. metal poisoning, parasitosis, intestinal obstruction).

Escalating Ingestion of Razor Blades in a Patient With Borderline Personality Disorder.

To the Editor: The means employed in self-injury vary widely among patients with borderline personality disorder and so may the magnitude of the damage inflicted. Deliberate foreign body ingestion (DFBI) constitutes a distinct behavioral syndrome that is frequently associated with borderline personality disorder. While with other forms of self-injurious behavior the patient usually achieves an immediate release of tension, such release is not generally the case in DFBI, as is illustrated in the present case. Case report. A 23-year-old woman who had previously been diagnosed with borderline personality disorder, according to ICD-10 criteria, presented with an increase in self-injurious behaviors after a recent miscarriage. The patient herself contacted police regarding increasing suicidal tendencies, which led to her admission to a psychiatric ward. Physical examination at admission revealed old scars and superficial cuts on arms and legs as well as new deep cuts all over her torso. The patient received individual psychotherapy sessions as well as group skills training. During her stay, she repeatedly swallowed quartered pieces of broken razor blades, which she wrapped in wads of chewing gum. During the span of several weeks, she swallowed in excess of 30 such razor blade pieces essentially without complications. She always notified staff sometime after the act. Ingestion of razor blade pieces was confirmed by x-ray (Figure 1A). For the most part, these fragments were passed with no difficulty. However, several larger pieces were recovered endoscopically either for diagnostic purposes or because the patient had complained of pain in her abdomen. Figure 1. Repeated Ingestion of Broken Razor Blades in a Patient With Borderline Personality Disorder In all, the patient underwent 4 gastroscopy or colonoscopy sessions (Figure 1B and 1C). Luckily for the patient, no transmural lesions had occurred. At this point, it was deemed impossible to discharge the patient from the hospital because she was considered at acute risk of suicide. Subsequently, she attempted to swallow one-half of a 2-edged razor blade without chewing gum, which resulted in immediate esophageal perforation and, consequently, in mediastinal emphysema and an esophagotracheal fistula. The patient required intensive care and several courses of endoscopic sponge therapy to close the esophageal defect. During this time, she was regularly seen by liaison psychiatry. She gradually began to engage more actively in psychotherapeutic treatment. In parallel, self-injurious behaviors decreased, and the patient was eventually discharged. An elective readmission for dialectical behavior therapy was scheduled. Deliberate foreign body ingestion is a frequent occurrence in patients with borderline personality disorder, but may also occur in patients with psychosis, malingering, and pica. The latter condition is defined as the persistent ingestion of nonnutritive materials such as chalk or clay at an age at which this behavior is developmentally inappropriate. The course of DFBI is frequently chronic. Treatment is difficult. Evidence-based therapeutic interventions are largely lacking.1 In borderline personality disorder, most self-injurious behaviors are a means of affect regulation and frequently lead to a swift release of tensions. In general, this release does not appear to be the reason behind DFBI.1 The main drivers behind DFBI in borderline personality disorder seem to be an inappropriate need for attention as well as a desire to test the limits of the therapeutic relationship. Management of DFBI in borderline personality disorder poses a great challenge because of potentially lethal complications and the need for rapid medical attention. Here, it is the special role of the consultant-liaison psychiatrist to bridge the gap between medical and physical health care and to support medical and surgical colleagues in grappling with countertransference issues commonly involved in treating such patients. In our experience, it is frequently during the early period after a major complication has occurred that the patient becomes more open to psychotherapeutic interventions. Ideally, general psychiatric management and stabilization will gradually enable the patient to benefit from a specific psychotherapeutic intervention such as dialectical behavior therapy.1,2

Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.

Long-Term and Bizarre Self-Injurious Behavior

Repeated self-harm usually presents with associated psychopathology, mostly in the form of obsessive-compulsive disorder, malingering, or personality disorders, and may persist for many years. This case presentation focuses on self-harm involving the deliberate ingestion of foreign bodies. This behavior remains poorly understood, and the relevant literature focuses almost entirely on gastroenterological and surgical management, with little or no discussion of underlying psychological mechanisms, psychopathology, or psychotherapeutic intervention. The goal of this article is to begin to fill that gap by presenting the case of a young woman who was diagnosed with borderline personality disorder and followed for 20 years, who repeatedly swallowed objects as a form of self-harming behavior. The nosological status and possible functions of this behavior are discussed, as are the difficulties of caring for patients with such long-standing, repeated selfinjury. This case illustrates how the boundaries between different self-injurious behaviors are blurred and also how different self-injurious behaviors are likely to share common patterns, functional integrity, and meanings. It should also serve to remind us how far we have to go in terms of understanding, classifying, and successfully treating certain patients who present with longterm and bizarre self-injurious behavior.

Hard to swallow: a systematic review of deliberate foreign body ingestion

Objective Deliberate foreign body ingestion (DFBI) is often impulsively driven, repetitive and refractory to intervention and frequently necessitates multiple medical interventions. As such, the frustrations among health care providers are great, and the financial toll on health care is significant. Nevertheless, the literature on DFBI is sparse, and suggestions for treatment planning and management are limited. The authors sought to investigate and uncover efficacious treatments and strategies for preventing reoccurrence in DFBI. We build on earlier work by offering both broad and diagnosis-specific management strategies. Method A literature review was performed addressing the presentation, management and prevention of reoccurrences of DFBI. Four cases of DFBI are presented illustrating those psychiatric diagnoses (psychosis, malingering, obsessive–compulsive disorder and borderline personality disorder) most frequently encountered in hospital practice. Both broad and specific treatment approaches are presented. Results Patients engaging in DFBI are best managed through a multidisciplinary approach, following acute medical management. Successful strategies for the prevention of reoccurrences of DFBI are inconclusive. Conclusion Understanding the function of this behavior is critical in developing treatment for patients who engage in these dangerous, potentially life-threatening, self-injurious behaviors. An amalgam of medical, pharmacological and cognitive–behavioral interventions is recommended, as is additional research.

PA29 PRESUMPTIVE SAFETY FOR CELIAC PATIENTS OF WHEAT BAKED GOODS RENDERED GLUTEN-FREE DURING SOURDOUGH FERMENTATION

After several interviews, this teenager admitted participation to an unusual dietary party with three peers, 4 days before admission. They ate a “soup” formed by gravel, wheat flour and water, for slimming purposes. The soup recipe had been found on an unidentified web site. After the party, one of the friends underwent emergency appendectomy for appendix occlusion caused by a gravel stone, another had been admitted for acute abdominal pain followed by passage of gravel stones in the stool while the third eliminated the stones in the stools without any complaint. Discussion: This case-report highlights the risks related to improper use of uncontrolled information found on the internet. There is a rising and widespread use of the web among children and adolescents. Recent studies showed that adolescents disclose personal information and may display risky behaviour. Sylvia wanted to loose weight even though her BMI was normal (18.7 = 25th percentile for age and gender). Concerns about weight, body shape and dieting are common among adolescent girls and may represent risk factors for eating disorders. One’s body image perception is influenced by several factors, including personal, parental and friends’ judgement, sociocultural environment and media pressures, that are believed to encourage the development of an unrealistically thin ideal of body shape. Independent of age and BMI, parental and media influences on adolescents are predictive of becoming highly concerned with weight and a constant dieter. Abdominal ultrasound is usually the first-line (and often the only) imaging investigation performed in the diagnostic process of children with AAP, to exclude appendicitis or other surgical conditions (e.g. intussusception). Abdominal ultrasound has however limitations (e.g. presence of excessive intestinal gas and operator dependence) and does not always identify ingested foreign bodies. In this patient, the intestinal stones were indeed detected only by a standard abdominal x-ray. Conclusions: Acute or recurrent abdominal pain is a frequent complaint in adolescents, particularly of those experiencing emotional and socio-familial difficulties. A careful interview can help to identify risky behaviours that could be responsible for this distressing disorder. As suggested by this case-report, the use of junk information retrieved by uncontrolled internet sources should be investigated. The deliberate ingestion of foreign bodies is a possible cause of AAP in teenagers.