Ingestion of foreign bodies is a well-recognised problem in children and adults with psychiatric conditions and personality disorders.¹ Patients may be asymptomatic or may present with symptoms and signs of gastrointestinal obstruction, perforation and/or bleeding. A rare case of an ingested foreign body in the stomach causing pericardial tamponade is described here.

CASE REPORT

A 24-year-old woman with a history of personality disorder, borderline schizophrenia and alcohol abuse was an inpatient in a psychiatric hospital. She had a history of acts of deliberate self-harm including foreign body ingestion. She had ingested a plastic ball point pen 5 weeks earlier and was being managed conservatively. She was referred to the emergency department with increasing epigastric pain and general malaise. On examination, she was found to be febrile (38°C) and clinically shocked. Cardiac auscultation revealed a third heart sound. Abdominal examination revealed mild epigastric tenderness but no peritonitis. Laboratory tests showed a leucocytosis (38.5×10^{9 …}