title: Intentional foreign object ingestions: need for endoscopy and surgery.
abstract: BACKGROUND
  Intentional ingestion of foreign objects (IIFO) is common in the incarcerated population. This study was undertaken in order to better define clinical patterns of IIFO among prisoners. We sought to determine factors associated with the need for endoscopic and surgical therapy for IIFO.
  
  
  METHODS
  After obtaining permission to conduct IIFO research in incarcerated populations, study patients were identified by ICD-9 codes. Patient charts were reviewed for demographics; past medical history; IIFO characteristics; and diagnostic, endoscopic, and surgical findings. Univariate and multivariate analyses were performed using statistical software.
  
  
  RESULTS
  Thirty patients with 141 episodes of IIFO were identified. The mean number of ingested items per episode was 4.60. Endoscopy was performed in 97 of 141 IIFO instances, with failure to retrieve the ingested object in 21 of 97 cases (22%). Eleven instances (7.8%) required surgical intervention. On multivariate analyses, hospital admission was associated with elevated white blood cell count (odds ratio [OR] 1.4, P < 0.05) and number of items ingested (OR 1.3, P < 0.05). The need for endoscopy was independently associated with ingestion of multiple objects (OR 3.3, P < 0.05) and elevated white blood cell count (OR 1.3, P < 0.05). Surgical therapy was significantly associated with elevated white blood cell count (OR 1.6, P < 0.01) and with increasing number of ingested items (OR 1.07 per item, P < 0.05). Endoscopy is associated with significantly lower odds of surgery (OR 0.13, P < 0.01).
  
  
  CONCLUSIONS
  Intentional ingestion of foreign objects continues to pose a significant human and economic burden. The need for admission or therapy is frequently associated with leukocytosis. Further investigation is warranted into resource-appropriate triage of patients who present with IIFO.
authors.affiliation: Department of Anesthesiology, The Ohio State University, Columbus, Ohio 43210, USA.
authors.forename: Poorvi P
authors.initials: PP
authors.lastname: Dalal
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Otey
authors.forename: Emily A
authors.initials: EA
authors.lastname: McGonagle
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Whitmill
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Levine
authors.forename: Ryan L
authors.initials: RL
authors.lastname: McKimmie
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Thomas
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Papadimos
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Reilley
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Stanislaw P A
authors.initials: SP
authors.lastname: Stawicki
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D004435:Eating; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005547:Foreign Bodies / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Correctional institutions; Endoscopy; Foreign body ingestion; Inmates; Intentional ingestion of foreign objects; Laparotomy; Prisoners; Swallowers