Multiple Metallic Foreign Bodies in the Gastrointestinal Tract in a Patient with Polysubstance Use Disorder

Sir, A 48-year-old incarcerated male prisoner with a past medical history significant for polysubstance use disorder and personality disorder presented with a 3-day history of upper abdominal pain. He denied hematemesis, fever, diarrhea, hematochezia, or recent nonsteroidal anti-inflammatory drug use. On examination, he was hemodynamically stable, with mild epigastric tenderness but no guarding or rebound. Laboratory investigations revealed a hemoglobin level of 12.2 g/dL, with normal blood counts, coagulation parameters, liver, and renal function. Frontal and lateral abdominal radiographs showed multiple radiopaque metallic objects within the stomach and intestines, indicating intentional foreign body ingestion [Figure 1]. Due to the patient’s symptoms and the risk of upper gastrointestinal bleeding, an urgent upper gastrointestinal endoscopy was performed. The endoscopy confirmed several metallic objects in the stomach, which were removed using a snare device. No active bleeding, ulceration, or mucosal injury was observed during the procedure. The patient tolerated the intervention well, with no postprocedural complications, and was discharged back to the correctional facility the next day with psychiatric follow-up arranged.Figure 1: Frontal and lateral abdominal radiographs showed multiple radiopaque metallic objects within the stomach and intestinesIntentional foreign-body ingestion in adults is uncommon but mainly occurs in individuals with psychiatric illnesses such as schizophrenia, bipolar disorder, major depression, and substance use disorders, as well as among incarcerated populations.[1,2] Often, ingestion serves as a form of self-harm, impulsivity, psychosis (e.g., command hallucinations), or as a way to gain secondary benefits like hospital transfer.[3] Prompt psychiatric intervention is as important as endoscopic or surgical management. In patients with psychiatric symptoms, involving family caregivers or social supports can be crucial in preventing recurrence, often surpassing procedural interventions. Institutionalized psychiatric or incarcerated patients frequently present with recurrent ingestion episodes – studies have documented deliberate and repeated ingestion in 36 institutionalized individuals, highlighting the challenging clinical management and need for psychiatric strategies.[4,5] This case highlights that prompt endoscopic retrieval is vital in preventing serious complications. Long-term management should emphasize psychiatric stabilization, behavioral therapy, and strong involvement of caregivers or support systems to lower the risk of future episodes. In correctional settings, coordinated medical and psychiatric care is essential for enhancing outcomes, preventing recidivism, and alleviating healthcare burdens. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Research quality and ethics statement The authors followed applicable EQUATOR Network(http://www.equator-network.org/) guidelines, notably the CARE guidelinee, during the conduct of this report Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.