Surgical digestive emergencies in prisoners, about a prospective study.

Sir,

The prison environment is a breeding ground for a number of gastrointestinal diseases. It has been rarely studied and publications on this topic are rare. We tried to study the prisoners patients sent to our emergency department by the provincial penitentiary of Marrakech over a period of 1 year.

The total number of cases was 15. All patients were men. The average age was 29 years. The most common surgical emergency was voluntary ingestion of foreign bodies, which was found in nine patients (60%). Other diseases were rare, found only in one patient each: acute pancreatitis, primitive peritonitis pyloric stenosis, strangulated inguinal hernia and abdominal wound.

Abdominal pain was the most frequent cause of consultation found in four patients, followed by vomiting (three patients), abdominal distension (one patient) and hematemesis (one patient). All patients had an abdominal X-ray [Figures 1 and 2].

Figure 1 and 2

abdominal X ray showing foreign bodies

Seven patients underwent surgery (46%) and were operated upon by laparotomy: four for ingestion of foreign objects [Figures 3 and 4], one for pyloric stenosis, one for strangulated hernia and one for abdominal wound with evisceration. Other patients had conservative treatment or medial with medical supervision. The average length of hospital stay was 7 days (2-30 days). Two patients had post-operative complications as infection of necrosis (acute pancreatitis), which required radiologic drainage and a second case of wound infection (case of abdominal wound with evisceration).

Figure 3 and 4

picture of the ingested foreign body

The prison population is not representative of the general population. This population is usually male, aged 15-44 years, and from the lower classes. Prisoners often have a history of smoking, alcoholism, drug addiction, mental disorders and chronic diseases.[12]

In most published series, the reported reasons for consultation were dominated by the ingestion of foreign bodies, trauma of the abdomen and proctology disease.[3] In our series, the most common pathology was voluntary ingestion of foreign bodies.

Blaho et al. had also found a high incidence of ingestion of foreign bodies by studying two different populations from two prisons over a period of 5 weeks, during which 14 ingestions were observed.[4]