Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Am J Case Rep. 2021 Nov 15;22:e934164. doi: 10.12659/AJCR.934164.
BACKGROUND Recurrent intentional foreign body (RIFB) ingestion is a complex and costly issue among patients in prison and those with psychiatric disorders. Risk factors for RIFB ingestion include male sex, incarceration, and the presence of a psychiatric disorder. Most patients can be managed with observation and endoscopy. Surgery is indicated in cases involving perforation or obstruction. The literature on preventative strategies for RIFB ingestion is scarce. CASE REPORT A 23-year-old man required 6 admissions in 1 calendar year for intentional foreign body ingestions. The patient was living in prison and had a history of bipolar I disorder, schizophrenia, and borderline personality disorder. He underwent 9 endoscopic procedures that retrieved a total of 64 objects. The primary imaging modalities were abdominal X-ray and abdominopelvic contrast-enhanced computed tomography scan. The patient was managed with endoscopy and, in 2 cases, with observation alone. Serial abdominal examinations and abdominal films were used to monitor the progress of foreign bodies that were difficult to retrieve. A bowel regimen with polyethylene glycol facilitated the passage of the objects. The patient never required surgical intervention. The mean length of stay was 4.17 days. The recurrent ingestions may have been related to compulsions and family stress. CONCLUSIONS Interdisciplinary collaboration is paramount in formulating effective treatment plans and limiting recurrence. Proposed strategies to prevent RIFB ingestion include the removal of ingestible objects from the environment, specialized prison units for close monitoring, early psychiatric intervention with appropriate pharmacologic/behavioral therapy, and limiting hospital admissions to prevent secondary gain. Further studies are needed to determine the most effective approach to manage and prevent RIFB ingestion.
在监狱中的患者和患有精神疾病的患者中，反复故意吞食异物（RIFB）是一个复杂且耗费成本的问题。RIFB 吞食的风险因素包括男性、监禁和精神障碍。大多数患者可以通过观察和内镜治疗进行管理。如果出现穿孔或梗阻，则需要手术治疗。关于 RIFB 吞食预防策略的文献很少。
一名 23 岁男性在 1 个日历年内因故意吞食异物而需要 6 次住院治疗。该患者生活在监狱中，有双相情感障碍 I 型、精神分裂症和边缘型人格障碍病史。他接受了 9 次内镜手术，总共取出了 64 个异物。主要的影像学检查方法是腹部 X 射线和腹部盆腔增强 CT 扫描。该患者通过内镜治疗，在 2 例中仅通过观察进行治疗。通过连续的腹部检查和腹部 X 射线监测难以取出的异物的进展。使用聚乙二醇进行肠道治疗有助于异物的排出。该患者从未需要手术干预。平均住院时间为 4.17 天。反复吞食可能与强迫行为和家庭压力有关。
跨学科合作对于制定有效的治疗计划和限制复发至关重要。预防 RIFB 吞食的建议策略包括从环境中清除可食用物品、设立专门的监狱单位进行密切监测、早期进行适当的药物/行为治疗以进行精神干预、以及限制住院以防止继发获益。需要进一步研究以确定管理和预防 RIFB 吞食的最有效方法。
