Deliberate Foreign Body Ingestion Research Articles

Cancer risk from diagnostic radiology in a deliberate self‐harm patient

Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. Case presentation and discussion. A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH.

Recurrent Metallic Foreign-Body Ingestion in a Patient with Partial Deletion of Chromosome 15 and Impulse Control Disorder

Purpose: Deliberate ingestion of foreign-bodies presents a unique challenge to physicians. It carries a sense of insidiousness for the patient with lack of external evidence of harm but a latent risk of further injury. Methods: A 35 year old Caucasian male presented with history of multiple episodes of swallowing sharp metallic foreign objects, typically paper clips. During all his presentations, there was a frank acknowledgement of ingestion with denial of any suicidal intent. His swallowing behavior had begun at the age of 29 and had resulted in forty hospitalizations for endoscopic procedures and surgeries for foreign body removal. Past history was significant for birth by emergent C-section and reported oxygen deprivation at birth, partial deletion of chromosome 15, mild mental retardation, delayed developmental milestones and behavioral problems with multiple psychiatric hospitalizations since age nine, impulse control disorder, alcohol abuse, pseudoseizures, and long history of self-injurious or parasuicidal behavior. With multiple episodes of foreign-body ingestion, it became difficult to retrieve the foreign-body endoscopically due to distortion of the gastroduodenal anatomy from prior adhesions and strictures related to multiple surgeries. In some instances, the endoscopic removal was deemed unsafe due to either impaction of the sharp foreign bodies or their advancement beyond the duodenum sweep resulting in need for open laparotomy. He was extremely resistant to psychiatric treatment or follow-up after these hospitalizations. Results: Ingestion of foreign objects is common in children, prison inmates, and those with psychiatric history or mental retardation. Majority of gastrointestinal foreign-bodies pass spontaneously. Sharp or pointed objects perforate the gastrointestinal wall in 15-35% cases, thus requiring endoscopic or surgical removal. Our patient with history of partial deletion of chromosome 15 (associated with mental retardation and behavioral problems) and oxygen deprivation at birth placed him at unique risk of impulse control disorder consequently resulting in a repetitive behavior of self-harm manifested as foreign-body ingestion. This type of self-injurious behavior is usually repetitive, non-suicidal, reported typically in women below age 30, and in patients with history of childhood abuse or neglect. Dialectical behavioral therapy, Naltreoxone and Clonidine have shown to have some benefit in preventing such behavior. Conclusion: Recurrent foreign-body ingestion is an uncommon but devastating presentation of patients with severe personality disorders. Its association in patients with partial deletion of chromosome 15 and impulse control disorder presents a unique perspective to this case.

Ingestión reiterada de cuerpos extraños y autoagresiones abdominales como intento de suicidio

Abstract:Accidental ingestion of foreign bodies is fairly common in the general population. However, recurrent, deliberate ingestion of foreign bodies associated with continual abdominal self-mutilation with blunt objects is extremely unusual. We present the case of a young woman with an underlying psychiatric disorder who repeatedly presented to the emergency department of our hospital for attempted suicide. The most frequent reason for presenting to the emergency department was ingestion of multiple objects, usually sharp metal objects, frequently associated with abdominal selfmutilation using a sharp instrument. Treatment consisted of extraction of the foreign bodies through upper gastrointestinal endoscopy or abdominal surgery. The patient has survived all these attempts with minimal morbidity.

Deliberate ingestion of foreign bodies by institutionalised psychiatric hospital patients and prison inmates.

Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients presented with few, if any, symptoms. A majority of objects pass spontaneously or remain in situ without complication. Twenty-four patients were discharged following initial evaluation and without specific treatment. Eight of these were reviewed electively and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastrointestinal endoscopy was performed in four patients and an intragastric foreign body identified in two cases. Laparotomy was performed in two cases for unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.