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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 162-168
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.162
Intentional ingestions of foreign objects among prisoners: A review
David C Evans, Thomas R Wojda, Christian D Jones, Andrew J Otey, Stanislaw P Stawicki
David C Evans, Thomas R Wojda, Christian D Jones, Andrew J Otey, Stanislaw P Stawicki, Department of Surgery, the Ohio State University, Columbus, OH 43210, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: The authors have no relevant conflicts of interest regarding this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David C Evans, MD, Department of Surgery, the Ohio State University, 395 W 12th Ave #634D, Columbus, OH 43210, United States. david.evans@osumc.edu
Telephone: +1-614-2939348 Fax: +1-614-2939155
Received: August 22, 2014
Peer-review started: August 23, 2014
First decision: November 18, 2014
Revised: December 10, 2014
Accepted: December 18, 2014
Article in press: December 19, 2014
Published online: March 16, 2015
Processing time: 209 Days and 15.7 Hours
Abstract

The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects (e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.

Keywords: Ingestion, Foreign body, Endoscopy, Prisoner, Swallower, Prevention, Recurrence

Core tip: Intentional ingestion of foreign objects typically involves ingestion of small objects (e.g., paperclips, razor blades, pens, eating utensils). Most episodes can be managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. Due to the documented pattern of escalation, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, and significant healthcare and security costs. There are no proven prevention strategies, but efforts to closely monitor patients and provide early psychiatric intervention are among recommended best-practice strategies.