Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury

[Incorporation of multiple foreign bodies due to borderline personality disorder]

BACKGROUND

Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature.

CASE REPORT

A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies.

DISCUSSION

The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.

An interesting case of a wandering foreign body in the tracheobronchial tree

Inhaled foreign body (FB) is a rare clinical entity for the ENT surgeon. We present a case of an inhaled foreign body in the right main bronchus shown to move to the left main bronchus by repeat chest X-ray during a delay prior to removal. The role of repeat chest X-ray if there is a significant delay before removal of an inhaled foreign body and the optimal management are discussed.