Intentional Foreign Body Ingestions: A Complex, Recurrent and Costly Issue

Patient: Male, 23-year-old Final Diagnosis: Foreign body ingestion Symptoms: Abdominal pain • nausea Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Psychiatry • Toxicology OBJECTIVE: Rare disease BACKGROUND: Recurrent intentional foreign body (RIFB) ingestion is a complex and costly issue among patients in prison and those with psychiatric disorders. Risk factors for RIFB ingestion include male sex, incarceration, and the presence of a psychiatric disorder. Most patients can be managed with observation and endoscopy. Surgery is indicated in cases involving perforation or obstruction. The literature on preventative strategies for RIFB ingestion is scarce. CASE REPORT: A 23-year-old man required 6 admissions in 1 calendar year for intentional foreign body ingestions. The patient was living in prison and had a history of bipolar I disorder, schizophrenia, and borderline personality disorder. He underwent 9 endoscopic procedures that retrieved a total of 64 objects. The primary imaging modalities were abdominal X-ray and abdominopelvic contrast-enhanced computed tomography scan. The patient was managed with endoscopy and, in 2 cases, with observation alone. Serial abdominal examinations and abdominal films were used to monitor the progress of foreign bodies that were difficult to retrieve. A bowel regimen with polyethylene glycol facilitated the passage of the objects. The patient never required surgical intervention. The mean length of stay was 4.17 days. The recurrent ingestions may have been related to compulsions and family stress. CONCLUSIONS: Interdisciplinary collaboration is paramount in formulating effective treatment plans and limiting recurrence. Proposed strategies to prevent RIFB ingestion include the removal of ingestible objects from the environment, specialized prison units for close monitoring, early psychiatric intervention with appropriate pharmacologic/ behavioral therapy, and limiting hospital admissions to prevent secondary gain. Further studies are needed to determine the most effective approach to manage and prevent RIFB ingestion.