Endoscopic removal of unusual gastric impaction of 30 keys and magnets in a schizophrenic patient: a rare case report

TL;DR

A schizophrenic patient swallowed 30 keys and magnets, which were safely removed via endoscopy, highlighting risks and management in psychiatric foreign body ingestion.

Contribution

Presents a rare case of intentional ingestion of multiple metallic objects in a psychiatric patient and successful endoscopic removal.

Findings

Flexible endoscopy successfully removed 30 keys and 2 magnets from a patient's stomach.

Psychiatric evaluation and intervention were crucial in preventing future ingestions.

Early recognition and minimally invasive retrieval prevented complications like perforation.

Abstract

Foreign body ingestion is a common emergency, but intentional ingestion among psychiatric patients often involves multiple and unusual objects that create significant diagnostic and therapeutic challenges. We describe a 35-year-old man with an 11-year history of untreated schizophrenia who presented with recurrent vomiting, abdominal pain, and abdominal distension. Abdominal radiography revealed a metallic mass in the stomach, and endoscopy identified numerous metallic objects, including 30 keys and 2 magnets, with minor mucosal ulcerations. All items were successfully removed using flexible endoscopy, and follow-up imaging confirmed complete clearance. The patient subsequently underwent psychiatric evaluation, and repeat endoscopy the next day showed normal findings. This case emphasizes the heightened risk of recurrent ingestion in psychiatric populations, particularly when magnets or sharp objects are involved, which may result in ulceration or perforation. Early recognition, minimally invasive retrieval, and appropriate psychiatric intervention are essential to preventing complications and reducing recurrence.

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