A case study from the Trauma and Emergency Unit of the Inselspital, Bern; one of Switzerland’s largest trauma units.
Patients are frequently admitted to emergency departments after foreign body ingestion and it is estimated that over 1500 people die each year in the USA alone following these incidents. Accurate diagnosis and treatment are therefore crucial in avoiding severe complications in the oesophagus or gastrointestinal organs. Plain X-ray imaging is frequently used in Emergency Departments (ED) for detection, assessment and treatment planning in cases of foreign body ingestion. While most patients are children, ingestions can occur in adults who are mentally unstable, alcoholic, prisoners or drug smugglers. This study reports on the assessment of a mentally unstable patient at the Emergency Unit (EMU) of the Inselspital, Bern, Switzerland.
This 19 year-old female patient was brought to the ED by family members.They reported that the patient may have ingested a foreign object, since she was observed the evening before possibly swallowing something in the bathroom. The patient suffers from a psychological disorder and was not willing to co-operate with ED staff, give a history or undergo physical examination. Possible imaging investigations were discussed. Computed Tomography (CT) was suggested for its high sensitivity and specificity, but was not viable since the patient refused to lie in a closed scanner. The high radiation was also seen as a disadvantage. Serial conventional X-rays were dismissed because of the overlapping imaging technique, and associated radiation exposure, that would be required to locate the object/s. Lodox scanning was chosen to provide a full-body X-ray image that could be performed in the ER. The large format image was seen as an advantage due to the marginal background information available. The very low radiation exposure was judged as safer for this young patient with limited history.