Article InfoFigure 1
Frequency distribution of number of intentional foreign body ingestions, according to individual patients.
Figure 2
Deliberate ingestion of a serrated knife blade in a patient with adjustment disorder with depressed mood, not diagnosed as having suicidal intent. (A) Chest radiograph showing knife blade (arrow) tip down in esophagus. (B) Same serrated knife tip now lying within stomach. (C) Successfully removed knife blade.
Figure 3
(A) Categories of costs incurred in patient care, and (B) total payer mix.
Figure 4
Proposed algorithm for the management of foreign body ingestions.
Background & Aims
Guidelines support endoscopic removal of certain gastric foreign bodies (FBs) and all FBs lodged in the esophagus. We studied the poorly understood group of patients who intentionally ingest FBs.
Methods
Cases of intentional ingestion of FBs (n = 305) were identified, retrospectively, from an electronic endoscopy database and followed. Cases occurred among 33 different patients, who underwent endoscopy from October 1, 2001, to July 31, 2009 (39.0 cases/year); 79% were diagnosed with a psychiatric disorder. Financial cost analysis was performed using hospital billing and cost systems.
Results
Commonly ingested FBs included pens (23.6%), batteries (9.2%), knives (7.2%), and razor blades (6.9%). Most endoscopic procedures were performed under general anesthesia. FBs were commonly retrieved by snares (58.0%), rat-toothed forceps (14.4%), and nets (11.5%), assisted sometimes by use of overtubes (10.8%), and hoods (4.6%). FB extraction was unsuccessful at the initial endoscopy in only 20 cases; 2 cases eventually required surgical extraction. Minor complications occurred in 11 endoscopies. There were no deaths or perforations. The total estimated costs were $2,018,073 ($1,500,627 in hospital costs, $240,640 in physician fees, and $276,806 for security services). Costs were significantly higher for inpatients. Major payers were Medicare (48%) and Medicaid (31%).
Conclusions
Intentional FB ingestion occurs among a relatively small number of patients with psychiatric disorders and is costly. Endoscopic retrieval is relatively effective and safe, but often requires general anesthesia. These cases utilize significant hospital and fiscal resources. Attention should be focused on preventing these recurrent and costly episodes.
Abbreviations used in this paper:
ASPD (antisocial personality disorder), BLPD (borderline personality disorder), FB (foreign body), FBI (foreign body ingestion), SIB (self-injurious behavior)
