Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion

Abstract

Background: Previous reports of foreign-body ingestions focused primarily on accidental ingestions.

Objective: To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population.

Design: A retrospective case series.

Setting: An urban county hospital.

Patients: Patients >/=17 years old, with foreign-body ingestions between 2000 and 2006.

Main outcome measurements: Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications.

Results: Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if </=48 hours) and from presentation to intervention (15/40 [38%] if >48 hours vs 14/165 [8%] if </=48 hours). Perforation occurred in 16 cases (6%), with 6 perforations noted after endoscopy.

Limitation: A retrospective review of medical records.

Conclusions: Foreign-body ingestions in an urban county hospital occurred primarily in psychiatric patients who had repeated episodes of intentional ingestions. Endoscopic extraction was unsuccessful in 10% of cases. Long delays from ingestion to presentation and intervention may account for relatively high rates of surgery and perforation. Strategies to prevent ingestions and delays in endoscopic management are needed in this population.