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智障患者吞食异物的倾向:一例因吞食茶匙导致回肠穿孔的病例

Tendency to Ingest Foreign Bodies in Mentally Retarded Patients: A Case with Ileal Perforation Caused by the Ingestion of a Teaspoon.

作者信息

Yıldız İhsan, Koca Yavuz Savaş, Avşar Gökhan, Barut İbrahim

机构信息

Department of General Surgery, Suleyman Demirel University School of Medicine, 32260 Isparta, Turkey.

出版信息

Case Rep Surg. 2016;2016:8075432. doi: 10.1155/2016/8075432. Epub 2016 Feb 23.

Abstract

Introduction. Unintentional foreign body ingestion commonly occurs accidentally in children aged between 3 months and 6 years and at advanced ages or results from psychiatric disorders such as hallucination in patients with mental retardation. Most of the ingested foreign bodies are naturally discharged from the body but some of them may require surgical intervention. Presentation of Case. A 29-year-old mentally retarded female patient was admitted to the emergency service with a two-day history of abdominal pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, defense, and rebound on palpation. Radiological examination revealed diffuse air-fluid levels and a radiopaque impression of a metal object in the right upper quadrant. The metal teaspoon causing ileal perforation was extracted by emergency laparotomy. On postoperative day 7, the patient was uneventfully discharged following a psychiatric consultation. Discussion. Foreign body ingestion can occur intentionally in children at developing ages and old-age patients, or adults and prisoners, whereas it may occur unintentionally in patients with mental retardation due to hallucination. However, repeated foreign body ingestion is very rare in individuals other than mentally retarded patients. Conclusion. Mentally retarded patients should be kept under close surveillance by surgeons and psychiatrists due to their tendency to ingest foreign bodies.

摘要

引言。意外吞食异物常见于3个月至6岁的儿童以及高龄人群,或是由精神障碍导致,如智障患者出现幻觉时。大多数吞食的异物会自然排出体外,但有些可能需要手术干预。

病例介绍。一名29岁的智障女性患者因腹痛、恶心和呕吐两天被送往急诊。体格检查发现腹部压痛、肌卫和反跳痛。影像学检查显示弥漫性气液平面,右上腹有一个不透X线的金属物体影像。通过急诊剖腹手术取出了导致回肠穿孔的金属茶匙。术后第7天,经精神科会诊后患者顺利出院。

讨论。发育中的儿童、老年患者、成年人及囚犯可能会故意吞食异物,而智障患者可能因幻觉意外吞食异物。然而,除智障患者外,其他人反复吞食异物的情况非常罕见。

结论。由于智障患者有吞食异物的倾向,外科医生和精神科医生应密切监测他们。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d0a/4781951/3a5442b1067d/CRIS2016-8075432.001.jpg

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