Ingestion, insertion and malpractice of foreign objects is a interesting topic among medical professionals for the past few years or more. It has been discussed in medical studies, such as emergency medicine, gastroenterology, urology and surgery. This essay would illustrate clinical studies from practice of deliberate ingestion, insertion or even malpractice of objects left behind in patients and then examines specific aspects of these behaviors that are critical to achieving a better understanding of it.
By taking a comprehensive approach, the goal is to stimulate a greater appreciation of this behavior by doctors or researchers and conclusively to arrive at a revised practice guideline surrounding these cases, including an enhanced management approach and a more informed therapeutic plan. The case of intentionally inserting and ingesting foreign objects into the body appears with a few reassurances in the medical studies, mostly in anecdotal reports of radiological and surgical practices.
A recent national survey of American prisons revealed that approximately two percent of inmates per year engage in self-injurious behavior, including intentional insertion or ingestion of foreign objects, with at least daily occurrences in some systems and the highest rates occurring in maximum-security and lockdown units”(Klein). “A study examining foreign object ingestion reported that this phenomenon may account for as many as 1,500 fatalities per year in the United States. The majority of ingestion cases, up to 80% to 90%, result in spontaneous passage through the gastrointestinal (GI) tract.
Also 10 to 20 percent require a nonoperative intervention such as an endoscopy, whereas less than 1% need surgical intervention due to obstruction, perforation, or hemorrhage. Areas of physiological narrowing or acute angulations in the GI tract are the potential sites for impaction, obstruction, or perforation. Symptomatic patients tend to present with clinical signs and symptoms, such as pharyngeal discomfort, dysphagia, pain, vomiting, upper and lower GI bleeding, or acute abdomen”(Klein).
A lawsuit was filed against an Oklahoma hospital after a surgical sponge was forgotten inside a patient’s knee when the patient had undergone an ACL surgery. Due to the infection and several follow-up surgeries to correct the problem the patient said she could’t run anymore and is in constant pain. She said that something was wrong and that she was in pain and it just didn’t get any better. Her mother called the doctor, and a foreign object was discovered inside the patient’s knee and a sponge was left behind after surgery.
The patients parents requested a copy of the x – rays but they didn’t send the x-rays with the sponge in it. They had to go back in and specifically ask for that X-ray so that they could get a copy of it. Another case was about how a patient visited her OB/GYN for a uterine ablation and tubal ligation. She was experiencing prolonged bleeding during her menstrual cycle, which left her in a great deal of pain, and had chosen the tubal ligation at the same time to prevent any future pregnancies. Usually these procedures are standard and rarely cause patients any complications post-op.
After enduring months of agonizing pain following her operation, which she described as being much more intense than the pain she had experienced prior to her surgery, she discovered a huge metal protrusion in her groin as she sat down to use the restroom. The physician accidentally left a surgical probe inside of her body upon completing the procedure. She received a pelvic examination and rather than discovering and/or identifying the offending foreign object in her body as the source of her symptoms, she was given a diagnosis of severe vaginal infection.
Her husband immediately took her to the Emergency Room where an X-ray showed she did, indeed, have a large medical instrument stuck in her vagina. It is estimated around 4,000 patients in America are left with some sort of surgical object in their body after undergoing operations per year. This is a frighteningly high number, considering people are putting their ultimate trust in the assumed-expert hands of doctors every day in the hopes of being cured, not killed.
It is alarming to think surgeons and their trained staff could be so distracted during a procedure, whether routine or major, they simply overlook or forget they’ve left a potentially deadly tool inside of someone. In these cases these were just a cause of negligence or malpractice. There was this young adult that had an extensive history of major depressive disorder, borderline personality disorder, and post-traumatic stress disorder. The development of illness was significant for self detrimental actions and multiple psychiatric admissions for reported suicidal intentions.
He underwent numerous surgical interventions and medical care, like removal of ingested foreign objects by endoscopy, such as pencils, pens, a toothbrush holder, plastic knives, paperclips, pieces of plastic, and a broken CD. The patient described the medical and surgical procedures as painful and subjectively distressing. Frequent ingestion of foreign objects continued secretly, despite repeated close observation. Ingestion episodes were covertly, without escalating behaviors or self awareness of mounting distress.
The patient had described motives for ingestion that included guilt about a dispute with his mother, anxiety evoked by rumination about the past, wishes to be removed from the world, feelings of desperation, and remote suicidal ideas. When researching the practice of intentional insertion and ingestion of foreign objects, it is important to determine five aspects of this behavior: the type of foreign object involved; the body site through which the foreign object is introduced; the motivation behind the behavior; the amount of foreign objects inserted or ingested; and any identified psychiatric diagnoses.
Being mindful of these five characteristics render into a better understanding of the behavior and ensures efficient management of potential clinical consequences. The ingestion of objects relates to their introduction through the mouth. Insertion, on the other hand, refers to introduction of objects through body orifices such as ear, nose, urethra, rectum, vagina, the skin, or into the orbit, pelvis, abdomen, or breasts. “An increased number of cases of self inflicted urethral foreign object insertion have been reported in the literature over the past decade”(Klein). This individual type of behavior occurs more often in male patients.
Recent case studies of foreign object insertion through the skin have been reported in female patients. However, the differential in gender predominance appears to vary in accordance to the body site involved. A review of the scientific composition reveals that a very wide array of objects, with different characteristics in size and shape, have been inserted and ingested in reported cases. “In a retrospective hospital review of 262 cases of foreign object ingestion in adults, the most commonly ingested items were identified as toothbrushes, pens, pencils, spoons, batteries, razor blades, pieces of glass, and paper clips”(Klein).
A similar study reported that glass objects, sharp metals, and batteries were the most frequently ingested foreign objects. In cases of foreign object insertion through the skin, the use of a straightened paper clips and a lengthy, thin object such as a needle and was the most common. In cases of urethral foreign object insertion, different types of wire and wire-like objects such as string, tubes, straws and cables were most commonly used. In cases where illegal substances were being trafficked, the object being inserted or ingested into the rectum and vagina were commonly packets of heroin or cocaine.
In medical studies on the issue of foreign object insertion or ingestion, featured cases often involved many foreign objects. They ranged from a case of ingestion of 71 metallic objects, including a razor blade, wire strings and a wrench, to the ingestion of 206 lead bullets by a patient that had schizophrenia. In another case report, the patient swallowed various needles, pins and nails before she committed suicide by hanging. “Hamilton Howard “Albert” Fish, an American serial murderer, was reported to have inserted 29 needles into his pelvic area through the skin between the rectum and the scrotum” (Klein).
The amount of foreign objects inserted or ingested is of particular concern, as it can affect the influence the therapeutic approach and the severity of the clinical presentation. The motivation that commute to these behaviors is of absolute importance when persistent intent of ingestion or insertion is considered. Drug trafficking plays a significant role in some cases in which the foreign object is typically inserted into the vagina or rectum. Not every case of foreign object ingestion or insertion is associated with an underlying psychiatric disorder.
However, it is imperative to address the underlying psychiatric problem promptly and to ensure appropriate psychiatric treatment to effectively prevent recurrence of the behavior. Foreign object ingestion in psychotic patients is associated with highly repetitive behavior and high numbers of objects swallowed. This behavior may be a manifestation of delusional beliefs or a response to command hallucinations, usually feature patients with schizophrenia. In patients with severe personality disorders, the repeated behavior of ingestion or insertion of foreign objects is generally viewed as a form of provocative, suicidal behavior.
Pica is most commonly seen in pediatric populations. However, when it occurs in adults, it is frequently associated with other psychiatric diagnoses such as mental retardation, autism, and schizophrenia. People with learning disabilities are more likely to put non-nutritive items in their mouths, often causing choking and, in some cases, death. How foreign objects found in the human body is related to us as radiology technologists is that we are the ones who help figure out what the problem is with these patients and we report it to the radiologist immediately.
For instance, if a patient came into the emergency room with pain somewhere and we take an x-ray we would see the object that was inside the patient. We would be the key to helping doctors figure out where the object is and help them to remove the object inside the patient in surgery. Sometimes the patient could be from a tragic accident and some stuff got lodge inside the patient and we need to know where and how deep the object was inside.