Self-Harm-Associated Gastrointestinal Foreign Bodies: National Patterns of Management and Outcomes

Gastrointestinal foreign body ingestion or insertion can be an act of intentional self-harm. We aimed to provide a large-scale assessment of this clinical scenario.

This is a retrospective cross-sectional analysis of adult patients who presented with gastrointestinal foreign bodies and intent to self-harm. Hospitalizations were identified using the National Inpatient Sample from 2016 to 2023. Each hospitalization was characterized by the management methods used including no intervention, endoscopy, and surgery. Evaluated outcomes included ICU-level care, length of stay, and cost. Additionally, we assessed factors associated with the need for surgery after endoscopy.

A total of 16,150 hospitalizations were identified. The mean age was 33.9 years and most patients were male (65.7%). Over one-third (35.2%) of patients had a cluster B personality disorder while 39.3% had schizophrenia and 24.2% were incarcerated. The majority (61.2%) of patients were managed with endoscopy alone while 26.4% required no intervention and 12.3% required surgery. ICU-level care was increased in those who required surgery, but the difference was not statistically significant (4.5% vs. 3.0%; OR 1.54, 95% CI: 0.91-2.62, p = 0.111). Small bowel location was associated with the need for surgery after endoscopy (aOR 2.50, 95% CI 1.91-3.28; p < 0.001). Over 12,000 hospital days and $25,000,000 were attributable to self-harm-associated gastrointestinal foreign bodies annually.

Self-harm-associated gastrointestinal foreign bodies occur predominantly in patients with significant psychiatric comorbidity. Although mortality and severe morbidity are uncommon, healthcare utilization is substantial. Small bowel location is a key predictor of the need for surgical intervention.