Endoscopy for repeatedly ingested sharp foreign bodies in patients with borderline personality disorder: an international survey

Repeated foreign body ingestion as a dynamic game: A case report

In this case report, we correct the analysis of mitigating intentional foreign body ingestion offered by Sarah J. Diamond and Amnon Sonnenberg. Patients who notoriously swallow foreign objects generate significant economic costs to hospitals. In previous publications, it has been argued that hospitals might reduce the need for endoscopy by offering such patients a paid position to discourage foreign body ingestions. However, the game-theoretical analysis offered in the literature was based on a static game which did not justify the relevant equilibrium. To obtain the actual goal of keeping the patient away from foreign body ingestion, we consider a repeated game with an infinite horizon. We show that there exists a combination of strategies applied by the hospital and the patient that leads to a steady state in which the patient will be discouraged from foreign body ingestion.

[Ingestion of foreign bodies by young patients with borderline personality disorder]

Eight cases of young female patients with borderline personality disorder are reported. They presented between twice and 38 times for endoscopic extraction of ingested foreign bodies from the upper gastrointestinal tract. Thus, within a 3-year-period 265 foreign bodies were recovered at 143 endoscopies. Most frequently, spoon-handles of different lengths and broken fragments of china were extracted. Foreign bodies were almost always removed successfully and without complication. Only one knife firmly trapped between gastric fundus and antrum required a surgical gastrotomy. Depending on the type, size and number of the foreign bodies, the anticipated complexity of the endoscopic procedure and the reported fasting period approximately 40 percent of endoscopies were performed under airway protection by tracheal intubation. Despite considerable personal and material expenses most gastroenterologists, psychiatrists and surgeons advocate repeated foreign body extraction even in view of repetitive ingestion.

Liver perforation following foreign body ingestion: an important clinical lesson

A 25-year-old woman presented to the surgical unit with a 1-week history of ingestion of a pen. Examination revealed a minimally tender epigastrium with no peritonism. Investigations were unremarkable, with normal bloods and no free air on erect chest radiograph. At the time of endoscopy, the pen appeared to have perforated the lesser curve of the stomach. Endoscopic extraction was abandoned and a CT arranged, revealing the tip of the pen lying within the left lobe of the liver. The pen was removed at laparotomy with an uneventful recovery. This case highlights the importance of considering the potential for injury to other structures following gastric perforation, and the importance of having a low threshold for further imaging.

Review of foreign body ingestion and esophageal food impaction management in adolescents

Foreign body ingestion is a common clinical scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life threatening. Initial and follow-up management strategies depend on multiple patient and ingested object-related factors. Available literature on this topic tends to focus on the small child or adult, leaving the clinician caring for adolescents to extrapolate this information to guide decision making for individual patients. This article reviews foreign body ingestion literature with important implications to the adolescent patient and raises awareness of some highly dangerous objects such as large button batteries, high-powered magnets, long sharps, narcotic packages, and super absorbent objects. An additional focus includes the management of esophageal food impaction. We highlight the unique aspects to the care of the adolescent with intentional ingestion and co-morbid psychiatric illness. The article concludes by discussing the challenges to prevention of ingestion in the at-risk patient.