Recurrent Intentional Foreign Body Ingestion: An Endoscopist's Dilemma.

Patient #1 A 22-year-old African American male presented with abdominal pain and coffee ground vomitus after allegedly swallowing a pocketknife. The patient had been feeling depressed and had run out of his medications (duloxetine hydrochloride [Cymbalta, Lilly] and haloperidol) prior to the foreign body ingestion. His psychiatric history included major depression, borderline personality disorder, and bipolar disorder. The patient underwent an upper endo scopy for removal of the object (Figures 1–3). The endoscope was inserted, and the pocketknife was found in the stomach. A snare was placed around the pocketknife and then closed. The pocketknife and endoscope were then carefully withdrawn together. There was no obvious trauma from the procedure. The patient had had a similar presentation 3 weeks earlier when he had ingested 3 screws and 1 blade. At that time, he underwent an upper endoscopy for removal of the objects, which were lodged in his stomach. Since 2007, the patient has undergone 9 upper endoscopies and 2 colonoscopies at our institution as well as many more procedures at other hospitals. The patient has swallowed forks, bolts, screws, blades, steak knife blades, and pocketknives. He has also undergone multiple laparotomies for the management of foreign body ingestion since 13 years of age.