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The management of foreign bodies in the gastrointestinal tract is not standardized. Foreign body ingestions in prisoners are always intentional and inmates can be manipulative, which makes medical decision even more difficult. Our objective is to propose a decisional algorithm for management of foreign body ingestion in prisoners. We reviewed the records of 198 admissions for foreign body ingestion for a 10-year period. Type and number of ingested foreign bodies, radiographic findings, outcome as well as the management method including conservative, endoscopic removal, or surgical treatment were analyzed. Most cases were managed conservatively (87.6%). Endoscopy of the upper gastrointestinal tract was performed in 37 cases with a success rate of 46 per cent. In 9.3 per cent of cases, the final treatment was endoscopic. Only five patients required surgical treatment, being emergent just in one case. We advocate conservative treatment for asymptomatic patients with foreign body ingestion. Endoscopic removal is proposed for pointed objects or objects bigger than 2.5 cm located in the stomach. Objects longer than 6 to 8 cm located in the stomach should be removed by endoscopy or laparoscopy. Patients with objects in the small bowel or colon should be treated conservatively unless there are complications or they fail to progress.
DELIBERATE INGESTION OF foreign bodies occurs mostly in children and mentally retarded people but also in prisoners trying to access a medical facility as a protest. In prisoners, ingestion of multiple objects and recurrent episodes are common.
Foreign body impaction may occur at areas of anatomical narrowing or angulation with the crico- pharyngeus muscle and the ileocecal valve being the most clinically significant.1 On the other hand, the risk of perforation is higher if the objects are sharp or pointed.2, 3
Most foreign bodies pass through the gastrointesti- nal tract spontaneously.4, 5 However, endoscopy is the treatment of choice when the decision to remove the object is made, whereas surgery may be necessary in a small number of cases.
Material and Methods
The records of all prison inmates requiring admis- sion to the Penitentiary Unit of the Consorci Hospi- talari de Terrassa on the basis of foreign body ingestion were reviewed for a 10-year period (1999 to 2009). Patients with ingestion of narcotic material (body- packers) who were admitted by...