A Conservatively Managed Case of Intentionally Ingested Razor Blades in a Mentally Challenged Adolescent.

Sir,

We would like to draw your attention to a case of an adolescent male with underlying psychiatric illness, who presented to the emergency department (ED) after ingestion of razor blades and managed successfully with a conservative approach.

A 16-year-old male was brought to the ED with complaints of blood tinged vomitus and abdominal pain after ingesting razor blades 1 day back. He was diagnosed with conversion disorder previously and was on medications. On presentation, his vitals were stable. Clinical examination was within normal limits.

Rapid antigen test and nasal swab test for COVID-19 were done in the ED. X-ray of the abdomen showed two radiopaque foreign bodies (FBs) in the abdomen; each made out to be an half of a razor blade [Figure 1a]. Upper gastrointestinal endoscopy showed half of a razor blade in stomach which could not be removed due non availability of proper instrumentation [Figure 1b]. Noncontrast computed tomography (NCCT) of the abdomen localized one of the FBs to be in jejunum and the other in the ileum [Figure 1c and d].

Figure 1

On the day of presentation. Foreign body seen in plain X-ray of the abdomen (a), upper gastrointestinal endoscopy (b), noncontrast computed tomographic films (c and d)

He was planned for conservative management and was kept nil per oral with a plan to intervene as and when required. Initial laboratory parameters were within normal limits with hemoglobin of 12.8 g/dl.

He underwent serial clinical examination, radiological imaging, and laboratory tests. He developed melena and hematochezia on day 3. On day 4, the patient passed the FBs in stool, and X-ray of the abdomen did not show any FB. On day 5, repeat NCCT of the abdomen was done to confirm the absence of the FB in the gastrointestinal tract, and psychiatry consultation was done for counseling the patient. The patient was discharged on day 6.

The present case is a rare intentional ingestion of sharp FB in the times of COVID pandemic where surgical interventions can be counterproductive. Expectant management helped us tide over the impediments of psychiatry illness of the patient.

Managing a case of multiple sharp object ingestion is challenging. There are no definite guidelines. Existing literature is limited to case reports of complicated cases, showing conflicting rate of operative intervention from 4%–35%.[12] This case report shows the importance of conservative management in such cases. However, for standard practice, more studies are required to formulate guidelines for the management of sharp FB ingestion.

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 his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.