Intentional Foreign Body Ingestion Research Articles

Repeated intentional foreign body ingestion, what can be done?

Repeated intentional foreign body ingestion (RIFBI) in patients with Emotionally Unstable Personality Disorder (EUPD) is a common clinical presentation to the emergency department. The relationship between repeated foreign body ingestion and a co-existent personality disorder diagnosis is complex, making it challenging to manage. Our institution implemented a novel interdisciplinary model of care for RIFBI as a way of improving health outcomes in this cohort of patients. Our observations following the model of care are presented herein. We encourage other health networks to adopt this model of care for managing RIBFI in EUPD.

Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions.

Accidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed. A 33-item REDCap© survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations. During 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing ≤ 3 patients with RIFBI within the past 24 months and 4% reported seeing ≥ 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was ≥5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings. Most gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported.

Repeated foreign body ingestion as a dynamic game: A case report

In this case report, we correct the analysis of mitigating intentional foreign body ingestion offered by Sarah J. Diamond and Amnon Sonnenberg. Patients who notoriously swallow foreign objects generate significant economic costs to hospitals. In previous publications, it has been argued that hospitals might reduce the need for endoscopy by offering such patients a paid position to discourage foreign body ingestions. However, the game-theoretical analysis offered in the literature was based on a static game which did not justify the relevant equilibrium. To obtain the actual goal of keeping the patient away from foreign body ingestion, we consider a repeated game with an infinite horizon. We show that there exists a combination of strategies applied by the hospital and the patient that leads to a steady state in which the patient will be discouraged from foreign body ingestion.

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.

Intentional Foreign-Body Ingestion: Improving Safety While Reducing Recurrence on a Child and Adolescent Inpatient Unit

Intentional Foreign-Body Ingestion: Improving Safety While Reducing Recurrence on a Child and Adolescent Inpatient Unit

Body packing with pyloric stenosis successfully treated with open pack retrieval and gastric bypass

Foreign body ingestion unintentionally or intentionally in adults are not uncommon on the contrary to children. Intentional ingestion of illicit drugs or tobacco/drug pack is one common reason other than psychosis. Infrequently, body packing may end up with bowel obstruction with ‘drug pack’ impacted at various constriction point of gastrointestinal tract [1]. Here, we report a case of intentional foreign body ingestion by a jail inmate whom unfortunately also has pyloric stenosis. The clinic presentations and treatment strategy are discussed.

Intentional Foreign Body Ingestion in a Patient With Borderline Personality Disorder and Other Comorbidities

Intentional Foreign Body Ingestion in a Patient With Borderline Personality Disorder and Other Comorbidities

Intentional Ingestion of Foreign Bodies: A Physician’s Agony

Intentional foreign body ingestion is the phenomenon wherein one swallows a non-digestible object with the intent to cause self-injury. It is intentional in adult patients with a positive psychiatric history and can be a recurrent issue. Although the incidence of this condition is increasing, there are few existing articles on the subject that highlight its importance. This case report aims to present a unique patient encounter to emphasize the multispecialty approach required for management and provide an overview of the literature available on the subject regarding types of objects swallowed, selection of appropriate imaging modalities, and plans of management.

Foreign body ingestion: Is intervention always a necessity?

Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval. We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition. A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation. Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.

(PO-014) Ethical Dilemmas in Patients with Intentional Foreign Body Ingestion: Is There a Role For Standardized Policies?

(PO-014) Ethical Dilemmas in Patients with Intentional Foreign Body Ingestion: Is There a Role For Standardized Policies?

Endoscopic foreign body retrieval from the caecum - A case report and push for intervention guidelines.

Introduction and importanceEndoscopic foreign body retrieval in the upper gastrointestinal tract is well established, however indications for endoscopy for retained foreign bodies in the lower gastrointestinal tract and specifically the right colon is still being navigated [3]. A PubMed and Google Scholar search discovered a variety of case reports detailing various methods and indications for endoscopic retrieval of right sided colonic foreign bodies. This case report endeavors to supplement the literature so that guidelines can one day be established for colonoscopic retrieval of right-sided foreign bodies.Case presentation36-year-old male prisoner swallowed 6.5 cm nail clippers with a long-standing history of intentional foreign body ingestion (FBI) including multiple laparotomies for foreign body retrievals. Computerized tomography (CT) was used initially to confirm the position of the nail clippers. After almost two weeks of failure of the foreign body (FB) to move beyond the caecum as demonstrated on plain abdominal X-rays, the patient had a colonoscopy with successful retrieval of the FB.Clinical discussionThis case report hopes to encourage the consideration of colonoscopy for retrieval of right sided colonic foreign bodies that have failed to pass on their own and where an operation may come with increased risk (multiple laparotomies, multiple comorbidities, and higher anaesthetic risk for a general anaesthetic). Colonoscopy/endoscopy still has inherent risk and this patient did have an episode of temporary laryngospasm that required intubation and monitoring in the intensive care unit post operatively. Despite this the patient recovered and was discharged day one post procedure without further complication. The case report has been reported in line with the SCARE 2020 criteria (Agha et al., 2020 [2]).ConclusionIndications for consideration of endoscopic retrieval of foreign bodies in the right colon have not been entirely detailed as endoscopy is for upper gastrointestinal foreign bodies. This case report documents the indications for endoscopy in the clinical context of a recurrent FBI and a history of multiple laparotomies with failure of the FB to move beyond the caecum.

S606 Substance Abuse Disorder and Intentional Foreign Body Ingestion: A Review of Implications for Endoscopic Outcomes

S606 Substance Abuse Disorder and Intentional Foreign Body Ingestion: A Review of Implications for Endoscopic Outcomes

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.

S2218 A Multi-Specialty Approach to Foreign Body Ingestion

Introduction: Intentional foreign body ingestion represents a challenge to treat for emergency room physicians, endoscopists, and psychiatrists alike. Time from ingestion and composition of the ingested object are often unclear on initial presentation, making it difficult for endoscopists to determine the optimal timing for attempting procedural removal. Fortunately, over 80 percent of these ingested foreign bodies pass without the need for endoscopic intervention. We present a case, however, where emergent collaborative endoscopic intervention was needed. Case Description/Methods: A 29-year-old male with a history of schizoaffective disorder presented following purposeful ingestion of a foreign body. The patient was in a cemetery when he experienced auditory hallucinations instructing him to swallow his crucifix necklace. Following ingestion, the patient immediately experienced drooling, coughing, and dysphagia. Despite his attempts to self-expel the crucifix, it remained lodged. On arrival to the emergency department, the patient was intubated for airway protection. Initial laboratory findings were unremarkable except for a urine drug screen that was positive for amphetamines. Initially, the gastroenterology team was consulted, and EGD was pursued. An Olympus endoscope was inserted into the mouth and advanced under direct visualization to the upper esophageal sphincter where a metallic tip was seen. Rat tooth forceps were used to attempt to grasp the metallic object but resistance was met, and the procedure was aborted. Otolaryngology was then consulted and performed a direct laryngoscopy using a Lindholm laryngoscope. Evaluation showed that the distal aspect of the cross was down into the cervical esophagus while the right aspect of the cross was in the patient’s hypopharynx. The otolaryngology team was able to use a grasper to grab the clasp of the cross with successful removal. Following the procedure, the patient was safely extubated and eventually was eventually transferred to an inpatient psychiatric hospital. Discussion: This case highlights the importance of a multi-specialty approach to purposeful foreign body ingestion. Flexible endoscopy has become the instrument of choice in managing foreign bodies and, with the advent of retrieval devices, it has led to more than a 90 percent success rate of retrieval. Our case highlights that even when unsuccessful the importance of working alongside our otolaryngology colleagues can ensure safe outcomes.Figure 1.: X-ray imaging of an ingested crucifix requiring procedural removal.

Endoscopic management of intentional foreign body ingestion: experience from a UK centre

ObjectiveWe report on the increasing incidence and outcomes from intentional foreign body ingestion (iFoBI) presenting to our hospital over a 5-year period. The aim was to assess the impact on...

Operative Removal of 154 Objects in Chronic Compulsive Foreign Body Ingestion

Intentional foreign body ingestion presents as a chronic surgical challenge. We encountered a severe case of ingestion that had failed endoscopic retrieval secondary to the size, shape, and quantity of structures encountered. Open gastrostomy with removal of objects with care to prevent future hostile abdomen was performed with 154 total objects removed at completion. We report a lesson in approaching a clinical problem with thought to approach for the preservation of anatomical structures in potential future interventions.

Endoscopic retrieval of magnetic foreign body ingestions with a nasal bridle: description of a novel technique (with video)

Accidental and intentional foreign body ingestions are common and frequently require endoscopic intervention. Sharp metallic objects pose a risk of perforation to the entire GI tract and are often difficult to visualize among food and other matter in the stomach. Three patients with histories of multiple ingestions are considered. Metallic foreign bodies can be easily removed using a nasal bridle. A snare and magnetic catheter are used as endoscopic tools to extract various metallic items. The bridle technique was used in 68 endoscopies in 3 patients who presented numerous times for foreign body ingestions. The technique was successful in 66 of the 68 procedures, with no adverse events. The bridle technique is an easy and effective way to remove metallic foreign bodies and has many advantages over traditional, mechanical modes of foreign body retrieval.

Trends and clinical features of intentional and accidental adult foreign body ingestions in the United States, 2000 to 2017

Foreign body ingestions (FoBIs) are a common cause for medical attention. However, trends and patterns of adult FoBIs as well as associations with clinical comorbidities and behavioral attributes have not been elucidated beyond single institutional experiences. We utilized survey data from the National Electronic Injury Surveillance System to examine fundamental characteristics of adult FoBIs involving consumer products between 2000 and 2017 across the United States. Data regarding the circumstances of FoBIs were abstracted from narrative data. Relationships among time, intent, demographics, and behavioral attributes were assessed using regression analyses, accounting for survey structure. Adult FoBIs have increased in incidence over the past 2 decades from 3 to 5.3 per 100,000 persons. Examination of consumer products revealed that jewelry (15.4%), nails (7.2%), and toothpicks (6.9%) were the most commonly ingested products. The most common products ingested varied over time, and the number of unique consumer product categories ingested increased from 103 to 143 in the time period studied. Intentional ingestions accounted for 14% of adult FoBIs and frequently involved plastic bagging (13.6%), batteries (13%), nails (10.1%), and desk supplies (6.8%). Adjusted regression analyses demonstrated that compared with accidental FoBIs, intentional FoBIs have increased over time. Intentional FoBIs were more frequently associated with younger age, substance abuse, police custody, and mental and cognitive illnesses relative to accidental FoBIs. Our results indicate that adult FoBIs are an increasing burden of disease in the United States with social, psychiatric, and behavioral contributors to this trend.

Duodenal perforation nine months after accidental foreign body ingestion, a case report

BackgroundForeign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen.Case presentationA 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy.ConclusionsNegative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.

Intentional foreign body ingestion

Intentional foreign body ingestion