Self-harm by Sharp Foreign Body Ingestion

Ingestion of sharp foreign bodies is a less frequently encountered method of selfharm. This study aims to follow up patients presenting with foreign body (FB) ingestion requiring urgent endoscopic intervention under general anaesthetic in theatre, characterise each patient and establish whether admission or removal of the FB promotes further self-harm.

Eleven adult patients, totalling 38 presentations over a 28-month period were identified. Each was followed up from an initial presentation requiring endoscopy.

9/11 (81.9%) where transferred either from prison or psychiatric care with an extensive history of multimodal and usually violent self-harm. Of these 8/9 (88.9%) had a formal psychiatric diagnosis linked to their previous self-harm. Objects retrieved included pens, razor blades, cutlery, wiring, batteries, a metal screw and a TV aerial. The median time between presentations with self-harm was 11 days. Those discharged from the emergency department re-presented after a median of 7.5 days. This was longer, at 14 days, if admitted to hospital; with those having endoscopic procedures re-presenting after a median of 11 days.

Inpatient endoscopic removal of the FB was not associated with an earlier presentation with further self-harm when compared with discharge straight form A+E, but was frequently repeated, often in a characterised manner.