Ingestion of Sharp Foreign Objects: A Case Series, Literature Review and Management Recommendation

Background: Current guidelines on the management of ingested sharp objects recommend the endoscopic removal of sharp objects from proximal to the pylorus and close monitoring for those that have progressed beyond the pylorus. The most recent guidelines focus primarily on the nature of the ingested object, disregarding the patient, have changed little since the 1990s and are based on, in general, low quality evidence. Case series: This is a case series of ten separate attendances to the Emergency Department by four patients with accidental or deliberate ingestion of sharp objects. Three patients with a history of deliberate self-harm and borderline personality disorder, known to psychiatric services, had ingested a variety of objects including safety razor blades (up to 20), pencils and a tooth brush. The fourth patient accidentally swallowed a pencil sharpener. Radiologically identifiable foreign objects below the gastro-oesophageal junction were seen in all cases. Five cases proceeded to endoscopy. In two all of the foreign objects were removed. One case proceeded to gastrotomy with subsequent post-operative complications. As the series progressed we switched to a more conservative approach favouring observation and earlier discharge without intervention. No complications resulting from the foreign objects were identified during a follow-up period of up to 4 months. Psychological management also changed including avoidance of restrictive interventions, such as use of the Mental Health Act, and approaches enhancing coping mechanisms were emphasized. Another important aspect to management was more focus on interdisciplinary support, liaison and education between medical, surgical and psychiatric teams.