Qureshi A1*, Cunningham J2 and Naz S3Fulltext PDF
Background: Foreign Body (FB) insertion is common presentation in emergency surgery and gastroenterology; there are guidelines available for management of accidental insertion of FB. The primary aim of this study was to look at demography, common site of insertion, common operation for retrial of FB and documentation of mental health diagnosis in patients admitted with FB insertion on surgical ward. We also looked at the literature and discussed most common psychiatric diagnosis and there presentation in these patients.
Method: We retrospectively analyzed data for all the patients admitted with diagnosis of FB in our hospital. The admission under general surgery, pediatrics, ENT and urology subspecialties were all included. Children with genital FB were excluded as they were transferred to pediatric surgery due to safeguarding issues. Retrospective data for last 4 year from January 2014 to January 2017 was collected using hospital electronic record system. Online e discharge summaries, operation theatre record and PACE radiology system was used to collect the date. Number of episodes of admission for each patient was recorded using online system. Patients were divided into accidental and MHI groups. MHI subgroup analysis was done to identify above mention characteristics.
Results: A total of 146 patients with diagnosis of FB were admitted in above mentioned period. 57% (84) were with a diagnosis of accidental ingestion out of which 70% ( 54) were under the age of 16 years predominantly male with most common site of insertion was ENT. The commonest cause of accidental FB in adults was food bolus followed by fish bone. MHI group made 43% (63) of all the patients admitted with diagnosis of FB insertion. We recorded 257 episodes for these 63 patients, with maximum of 21 episodes in one patient. Mean age was 25 ± 21. Female sex and younger age group were at higher risk of ingestion. Oesophagus, stomach and skin were most common site of insertion in female patients with MHI while Stomach followed by rectum was most common site of insertion in male patients with MHI. AXR was most common investigation in these patients. Endoscopic retrieval was successful in 85% of patients with FB in GI, Urinary and respiratory track. Most of the patients with diagnosis of MHI were either under psychiatric care or were referred during their admission. Surprisingly Patient with rectal FB were not referred or seen by psychiatric services. Three deaths were recorded one in accidental and two in MHI secondary to complications arising from FBs ingestion.
Conclusion: MHI patient are frequent attenders with recurrent presentations with FB ingestion in surgery or gastroenterology ward, their basic epidemiology and common presentation should be understood. Basic knowledge of common psychiatric problems among surgeons/medics can help during their acute admission on general ward. Early recognition and referral to mental health services can help and reduce future presentations.
Foreign body; Mental health illness; Deliberate self-harm
Qureshi A, Cunningham J, Naz S. Foreign Body (FB) Insertion is a Common Presentation in Emergency Surgery and Gastroenterology. Clin Surg. 2019; 4: 2407.