Intentional ingestions of foreign objects among prisoners: A review

Abstract

The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects (e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.

Keywords: Endoscopy; Foreign body; Ingestion; Prevention; Prisoner; Recurrence; Swallower.

Figure 1

Distribution of intentional ingestion of foreign objects in the gastrointestinal tract in inmate. (From Dalal et al[2] Figure 2, permission pending).

Figure 2

Paperclip in the ascending colon noted on colonoscopy (image rights belong to the authors).

Figure 3

Steak knife blades in the stomach (image rights belong to the authors).

Figure 4

Balls of narcotics wrapped in plastic wrap. These required surgical removal in a prisoner who was engaged smuggling activities by “body packing” (image rights belong to the authors).