A Mysterious Case of a 33-Year-Old Female Schizophrenic Patient Who Ingested a Kilogram of Metals: A Case Report

Abstract

Introduction: Globally, 20 million people are affected by schizophrenia. In Uganda, the prevalence is reported to be 710 per 100,000 population. Unlike normal adults who are less likely to have foreign body ingestion, patients with mental illnesses such as schizophrenia are at an increased risk of both intentional and accidental foreign body ingestion. Therefore, health workers must be vigilant while assessing such patients not to miss out on the diagnosis as unwitnessed foreign body ingestion presents a diagnostic challenge. Observation: We received a 33-year-old female diagnosed with schizophrenia four years before this admission as a referral. She presented at MNRH A&E with complaints of abdominal pain, non-bilious vomiting, and progressive weight loss. She had multiple admissions in private hospitals before her referral to MNRH where several investigations were done with inconclusive results. Upper GI endoscopy revealed multiple foreign bodies in the stomach. An erect abdominal x-ray was then done to rule out distal gastrointestinal involvement and/or perforation. An emergency laparotomy was performed and over 170 different metallic objects of varying sizes were completely evacuated. She reported that she ingested them in response to the compelling auditory hallucinations but had no intention of self-harm. Conclusion: Foreign body ingestion presents a diagnostic challenge in adults. The various impairments among mentally ill patients put them at an increased risk hence the need for suspicious diagnostic evaluation of those presenting with abdominal symptoms. Both health workers and families have a role to play in the prevention of such life-threatening emergencies.