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

Abstract

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.

Ingestion of foreign bodies among prisoners: a ten years retrospective study at University Hospital of Southern Italy

“…In these patients IFO can be due to malingering, personality disorders, pica and psychosis. The most frequent is malingering and the ingestion is always intentional, and often repetitive and sometimes ingestion of multiple items is associated to other autolesionistic behaviours (7). The percentage of pts who rejected endoscopy is higher in prisoners such as voluntary discharges without any diagnostic or therapeutic procedures.…”

Predictors of Recurrent Ingestion of Gastrointestinal Foreign Bodies

“…Yet, despite a plethora of data detailing the types and location of foreign bodies ingested, there are limited data detailing the groups at risk for intentional ingestion. In a small study of 36 patients, O'Sullivan et al (7) demonstrated that certain subgroups, such as prisoners and those with psychiatric illness, had a higher frequency of foreign body ingestion. Lee et al (12) also reported on the unusual, complex ingestions in a prison population.…”

Management Strategies for Ingestion of Foreign Objects in the Laryngopharynx

“…In adults, incidents of accidental foreign body ingestion are more common in certain vulnerable groups, such as prison inmates and patients suffering from psychiatric disorders, developmental delays, old age, or alcohol intoxication [2][3][4]. The types of foreign bodies most commonly ingested by children are fish bones and coins, and the types of foreign bodies most commonly ingested by adults are fish bones and chicken bones [5,6].…”