Acuphagia with sequential ingestion of sharp metallic objects and a magnet, causing intestinal bezoar, perforation,...

Acuphagia is a rare psychopathological subtype of pica, characterized by the deliberate ingestion of sharp metallic objects. It can lead to life-threatening complications, including intestinal obstruction, perforation, and peritonitis, and, in severe cases, death. The subsequent ingestion of a magnet further increases the risk of complications.

We report a unique case of a 16-year-old boy with no prior psychiatric diagnosis, presenting with severe abdominal pain for 2 months, absolute constipation for the last 4 days, along with fever and vomiting. History revealed sequential ingestion of small metallic bolts followed by a magnet. Clinical examination and imaging showed clustered radiopaque foreign bodies in the small bowel, causing intestinal obstruction and secondary peritonitis. Emergency exploratory laparotomy revealed five discrete perforations (three jejunal and two ileal). A 23 cm segment of the jejunum was resected to remove 15 metallic bolts and a magnet, followed by primary anastomosis, while two ileal perforations were managed with primary closure. Postoperatively, the patient was diagnosed with major depressive disorder and started on selective serotonin reuptake inhibitors and cognitive behavioral therapy.

The magnet likely caused clustering of previously ingested metallic bolts, forming a "metallic bezoar" that led to obstruction and perforation. This necessitated jejunal resection due to multiple perforations and pressure necrosis. This manuscript highlights the need to reconsider symptom-based postoperative imaging strategies. The patient's vocational environment was a key diagnostic clue.

Early recognition and prompt surgical intervention are essential in high-risk cases. A multidisciplinary approach, including psychiatric management and follow-up, is crucial to prevent recurrence.