DELIBERATE INGESTION OF FOREIGN-BODIES BY INSTITUTIONALIZED PSYCHIATRIC-HOSPITAL PATIENTS AND PRISON-INMATES

Deliberate and recurrent foreign body ingestion is a common problem am ong institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric pati ents, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in con trast, psychiatric patients presented with few, if any, symptoms. A ma jority of objects pass spontaneously or remain in situ without complic ation. Twenty-four patients were discharged following initial evaluati on and without specific treatment. Eight of these were reviewed electi vely and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastr ointestinal endoscopy was performed in four patients and an intragastr ic foreign body identified in two cases. Laparotomy was performed in t wo cases far unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.