1
|
Kaazan P, Seow W, Tan Z, Logan H, Philpott H, Huynh D, Warren N, McIvor C, Holtmann G, Clark SR, Tse E. Deliberate foreign body ingestion in patients with underlying mental illness: A retrospective multicentre study. Australas Psychiatry 2023; 31:619-624. [PMID: 37473424 PMCID: PMC10566206 DOI: 10.1177/10398562231189431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Deliberate foreign body ingestion (DFBI) is characterised by recurrent presentations among patients with mental health conditions, intellectual disabilities and in prisoners. We aimed to profile the characteristics and evaluate the care of such patients in this study. METHODS Adult patients with an endoscopic record of attempted foreign body retrieval between January 2013 and September 2020 were identified at three Australian hospitals. Those with a documented mental health diagnosis were included and their standard medical records reviewed. Presentation history, demographics, comorbidities and endoscopic findings were recorded and described. RESULTS A total of 166 admissions were accounted for by 35 patients, 2/3 of which had borderline personality disorder (BPD). Repetitive presentations occurred in more than half of the cohort. There was an increased trend of hospital admissions throughout the years. At least half of the cohort had a documented mental health review during their admission. An average of 3.3 (2.9) foreign bodies were ingested per single episode. Endoscopic intervention was performed in 76.5% of incidents. The combined Length of stay for all patients was 680 days. CONCLUSION Deliberate foreign body ingestion in mental health patients is a common, recurring and challenging problem that is increasing in frequency and requires collaborative research to further guide holistic management.
Collapse
Affiliation(s)
- P Kaazan
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - W Seow
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; and
- Department of Gastroenterology and Hepatology, The Royal Adelaide Hospital, Adelaide, Australia
| | - Z Tan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - H Logan
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia; and
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - H Philpott
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - D Huynh
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, Australia
| | - N Warren
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and
- Addiction and mental health services, Brisbane, Metro South health
| | - C McIvor
- Department of Gastroenterology and Hepatology, Logan Hospital, Logan, Australia
| | - G Holtmann
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia; and
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - S R Clark
- Faculty of Health and Medical Sciences, University of Adelaide, Brisbane, Australia; and
- Discipline of Psychiatry, Central Adelaide Local Health Network
| | - E Tse
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; and
- Department of Gastroenterology and Hepatology, The Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
2
|
Dudi-Venkata NN, Seow W, Kroon HM, Bedrikovetski S, Moore JW, Thomas ML, Sammour T. Safety and efficacy of laxatives after major abdominal surgery: systematic review and meta-analysis. BJS Open 2020; 4:577-586. [PMID: 32459069 PMCID: PMC7397346 DOI: 10.1002/bjs5.50301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend laxatives to reduce the duration of POI, but evidence is unclear. This systematic review aimed to assess the safety and efficacy of laxative use after major abdominal surgery. Methods Ovid MEDLINE, Embase, Cochrane Library and PubMed databases were searched from inception to May 2019 to identify eligible RCTs focused on elective open or minimally invasive major abdominal surgery. The primary outcome was time taken to passage of stool. Secondary outcomes were time taken to tolerance of diet, time taken to flatus, length of hospital stay, postoperative complications and readmission to hospital. Results Five RCTs with a total of 416 patients were included. Laxatives reduced the time to passage of stool (mean difference (MD) −0·83 (95 per cent c.i. −1·39 to −0·26) days; P = 0·004), but there was significant heterogeneity between studies for this outcome measure. There was no difference in time to passage of flatus (MD −0·17 (−0·59 to 0·25) days; P = 0·432), time to tolerance of diet (MD −0·01 (−0·12 to 0·10) days; P = 0·865) or length of hospital stay (MD 0·01(−1·36 to 1·38) days; P = 0·992). There were insufficient data available on postoperative complications for meta‐analysis. Conclusion Routine postoperative laxative use after major abdominal surgery may result in earlier passage of stool but does not influence other postoperative recovery parameters. Better data are required for postoperative complications and validated outcome measures.
Collapse
Affiliation(s)
- N N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - W Seow
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - H M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - J W Moore
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - M L Thomas
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|