Al-Faham Firas Shaker Mahmoud, Al-Hakkak Samer Makki Mohamed
Department of Surgery, College of Medicine, Kerbala University, Kerbala City, Iraq.
Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq.
Ann Med Surg (Lond). 2020 May 1;54:82-84. doi: 10.1016/j.amsu.2020.04.039. eCollection 2020 Jun.
The swallowing of foreign bodies can be accidental or intentional. The majority of the cases of accidental foreign body ingestion are observed in children. In adults, foreign body ingestion can be accidental, related to specific pathological changes of the digestive tract, or deliberate, as observed in patients with psychiatric diseases or in those released from the prison.
A 42-year-old male was admitted to the emergency department with symptoms including choking, drooling from the mouth, holding his neck, and aphonia. He had a history of psychiatric illness with suicidal ingestion of a foreign body. After stabilization, he was sent for chest radiograph, which revealed a significant radiopaque shadow the shape of a spanner, occupying the whole length of the esophagus. Emergency rigid esophagoscopy was performed to save the patient's life.
The patient swallowed the largest hard foreign body to harm himself or his family, to get the attention of his family, or as a suicide attempt. Such patients require urgent intervention by rigid esophagoscopy to reduce the risk of complications and to save the patients' lives. Further follow-up is essential due to the possibility of repeated foreign body ingestion.
While taking care of psychiatric patients, close observation by family members is mandatory to prevent them from harming themselves and to prevent suicide attempts by swallowing sharp, hard, large, and dangerous foreign bodies such as the size 17 wrench spanner observed in the present case.
异物吞咽可能是意外或故意的。大多数意外吞食异物的病例见于儿童。在成人中，异物吞食可能是意外，与消化道的特定病理变化有关，或者是故意的，如在精神疾病患者或出狱人员中所见。
一名42岁男性因出现窒息、流口水、掐脖和失声等症状被送入急诊科。他有精神疾病史，曾有吞食异物自杀的行为。病情稳定后，他被送去做胸部X光检查，结果显示有一个呈扳手形状的明显不透射线阴影，占据了整个食管长度。为挽救患者生命，进行了急诊硬质食管镜检查。
患者吞食最大的硬质异物是为了伤害自己或家人，引起家人的注意，或是企图自杀。这类患者需要通过硬质食管镜检查进行紧急干预，以降低并发症风险并挽救患者生命。由于存在再次吞食异物的可能性，进一步的随访至关重要。
在照顾精神疾病患者时，家庭成员必须密切观察，以防止他们伤害自己，并防止他们通过吞食尖锐、坚硬、大型和危险的异物（如本例中所见的17号扳手）来企图自杀。
