Ingestion of a saw-edge knife in a patient with mental illness: A unique and uncommon presentation

Background

Foreign body ingestion leading to complications is rare, and the need for surgery is even rarer. Foreign body ingestion in patients with mental illness poses challenges in diagnosis due to the varied and often delayed presentation and difficulties in history-taking. Symptom-based management in patients with mental illness may sometimes result in incorrect diagnoses and delayed treatment. Detailed history and investigation may uncover unexpected findings.

Case report

We present the case of a 28-year-old male patient with a history of depression and suicidal tendencies who admitted to ingesting a knife after repeated probing. Although there were no signs of peritonitis, abdominal imaging revealed a 17 cm saw-edge knife traversing from the duodenum to the adjacent right lobe of the liver. The patient successfully underwent exploratory laparotomy with knife removal, duodenotomy repair, and feeding jejunostomy.

Why should an emergency physician be aware of this?

A high index of suspicion is required to diagnose complications of foreign body ingestion, especially in patients with mental illness. In many high-volume emergency departments, these patients receive symptomatic management and are discharged with advice for outpatient follow-up. Emergency physicians should be aware that meticulous history-taking and a detailed examination are necessary in patients with mental illness. This approach facilitates a comprehensive diagnosis, timely management, and improved outcomes.