Foreign bodies in the abdomen: self-harm and personality disorders

Abstract

SUMMARYA 52-year-old woman presented to the accident and emergency department 5 h after deliberately stabbing herself with two pens through her midline laparotomy scar. Her medical history included an emotionally unstable (borderline) personality disorder and she was currently an inpatient in a psychiatric hospital. She had multiple accident and emergency attendances with previous episodes of self-harm. Clinical examination revealed evidence of trauma to her midline laparotomy scar with congealed blood covering the puncture site. Her abdomen was soft and non-tender on palpation. A chest radiograph revealed no air beneath her diaphragm and her abdominal radiograph identified a radiopacity in her upper right abdomen and dilated loops of small bowel. CT of the abdomen and pelvis confirmed two pens, with the lower pen tip reaching the pancreas. A midline laparotomy was performed and both foreign bodies were extricated unremarkably. The patient's postoperative recovery was uneventful. The second case involves a 22-year-old woman, a psychiatric hospital resident, presenting to the accident and emergency department 5 h after deliberately inserting the metal nib and inner plastic ink containing tube of a pen through her umbilicus. Her medical history included an emotionally unstable (borderline) personality disorder and paranoid schizophrenia. She had multiple accident and emergency department attendances with previous episodes of self-harm. Clinical examination revealed a soft, non-tender abdomen. Her chest radiograph was unremarkable and her abdominal radiograph identified a radiopaque foreign body at the right upper quadrant of the abdomen. CT of the abdomen and pelvis confirmed a metallic foreign body in the small bowel mesentery. An exploratory laparotomy converted to a midline laparotomy was performed and the foreign body was extricated. The patient's postoperative recovery was uneventful. BACKGROUND

Pneumoperitoneum in Rectal Polyembolokoilamania

“…Polyembolokoilamania represents a broad group of disorders characterized by the self-insertion of objects into body orifices caused by a number of psychosocial and psychological conditions. It is common in people who have a history of self-harm, personality disorders, schizophrenia, or alcoholism, as well as in prison inmates [ 9 ]. Adults who insert foreign objects, and often suffer from mental illness, have residual curiosities that manifest as experimentation, attempts to rekindle past memories or relationships, or do so to increase sexual arousal which is the most common motive [ 10 , 11 ].…”

“…Patients frequently give vague history as it was with this case. The situation is further complicated by the delayed presentation, which is sometimes due to embarrassment, or the varied presentations of the numerous items of various sizes and shapes that find their way into one's rectum [ 9 , 12 ]. In patients presenting with acute abdominal pain with or without psychiatric history, foreign bodies should always be part of the differential diagnosis.…”