Elsevier

The Journal of Emergency Medicine

Volume 16, Issue 1, January–February 1998, Pages 21-26
The Journal of Emergency Medicine

Clinical Communication
Foreign Body Ingestions in the Emergency Department: Case Reports and Review of Treatment

https://doi.org/10.1016/S0736-4679(97)00229-1Get rights and content

Abstract

We report a series of alleged ingestions of razor blades and other metal objects by prisoners presenting to an inner city Emergency Department. Fourteen claims of ingestions of razor blades or other metal objects involving eight prisoners occurred in a 5-week period. The motives behind the ingestions varied. Auditory hallucination was the most common reason given for the ingestions. Other motives included efforts to leave prison, depression, and accidental razor blade swallowing. Attempts were made in all patients to verify ingestions by radiograph. Some ingestions could not be confirmed by radiograph and were considered to be factitious. Only 1 of the 14 incidents resulted in hospital admission. All others were either treated in the Emergency Department or the patient was returned to jail with no treatment. No patient had a poor clinical outcome as a result of the ingestion, indicating that diagnostic radiographs and invasive procedures may not always be necessary. A review of treatment of foreign body ingestions is given as well as a summary of the treatment and outcome of these cases.

Introduction

Ingestion of foreign bodies for various reasons has been previously described 1, 2, 3, 4, 5, 6. There have been reports of a wide variety of objects ingested, ranging from coins to dental bridges [2]. The motives for the ingestions have varied as well. They include suicidal gestures or intent, self-mutilation, masochism, delusions, and oral exploration [1]. Ingestions of foreign objects by children are commonplace; the Poison Control Centers recently reported that 86% of metal coin ingestions are by children [2]. Most of the ingested foreign bodies pass through the gastrointestinal tract and are excreted without serious consequence 3, 4, 5, 6. Certainly, the characteristic of the ingested object affects the clinical outcome of the patient. Sharper objects such as chicken bones and toothpicks carry a greater risk of intestinal perforation, peritonitis, and sepsis 7, 8. Management of patients who ingest foreign bodies varies. Treatment can often be no more than observation and careful follow-up until the object passes through the alimentary tract or until the patient becomes symptomatic. More aggressive treatment of foreign body ingestion may include a laparatomy to remove the object.

We report a series of claims of razor blade ingestions by prisoners who were incarcerated at the local city or county prison. All patients were brought to our Emergency Department (ED) for treatment. In a 5-week period, there were 14 alleged ingestions in 8 different male prisoners.

Section snippets

Patient 1

A 45-year-old male was brought to the ED after an alleged razor blade ingestion. The patient had a history of paranoid schizophrenia with one previous suicide attempt. He was currently being treated with carbamazepine (Tegretol®), trifluroperazine (Stelazine®), paroxetine (Paxil®), dicumerol (Coumadin®), and diazepam (Valium®). He attributed this ingestion to “voices” that were instructing him to kill himself by swallowing a razor blade. An occult blood test and abdominal radiographs were

Discussion

Foreign body ingestion is more prevalent in patients who are incarcerated and those who have a history of psychiatric illnesses 4, 5, 6, 9, 10. Most ingested objects will pass spontaneously without consequence, especially after they pass through the stomach. Many of the patients who ingest foreign bodies have a history of multiple ingestions. James and Allen-Mersh [5] report a patient who swallowed objects repeatedly. Over a 12-year period, the patient swallowed safety pins, needles, hairpins,

Conclusions

The results from most studies on intentional foreign body ingestion show that the greatest majority of intentional ingestions occur in the prison population and in those with underlying psychiatric illnesses. The eight patients we reported had one or both of these characteristics. Most of the ingestions or alleged ingestions by the patients we described appeared to be attempts to receive attention and to be removed from prison. Not all ingestions could be verified and were therefore believed to

Acknowledgements

Acknowledgments—The authors thank Mrs. Barbara Edman and Jason Duncan for their superior editing and Kristina Brewer for her innumerable trips to the library.

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Clinical Communications (Adult) is coordinated by Ron M. Walls, md, of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

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