Fremdkörperingestionen bei psychischen Störungen: Was wissen wir und was sollen wir tun?

Zusammenfassung

Fremdkörperingestionen (FKI) bei psychischen Störungen sind ein häufiges und oft erheblich herausforderndes Versorgungsproblem. Während internationale Leitlinien zur gastroenterologischen Akutversorgung von Erwachsenen mit FKI existieren, ist die Datenlage im psychiatrischen Kontext quantitativ und qualitativ sehr begrenzt. FKI kommen bei nahezu allen psychischen Störungen, jedoch vermutlich am häufigsten bei Patienten mit Borderline-Persönlichkeitsstörung vor. Scharfe und spitze, besonders große (>2,5 cm Durchmesser) oder lange (>6 cm) Gegenstände sowie Batterien, insbesondere Knopfzellen, aber auch Magnete sind mit dem größten Risiko für FKI-assoziierte Komplikationen assoziiert. Dennoch werden etwa 80% aller Ingestate ohne Komplikationen nach 5 bis 6 Tagen fäkal ausgeschieden. Die psychiatrische Akutversorgung von FKI sollte eine Anamnese in Bezug auf Art und Anzahl ingestierter Fremdkörper, Zeitpunkt der Ingestion und eine körperliche Untersuchung mit Fokus auf Allgemeinzustand, Abdomen, respiratorisches System und Vitalparameter umfassen. Nicht jedes Ingestat muss endoskopisch entfernt werden, weshalb auch im psychiatrischen Setting die Kenntnis gastroenterologischer Leitlinienempfehlungen erforderlich ist. Bei wiederholten FKI sollten interdisziplinäre Besprechungen erfolgen, die allgemeine und fallbezogene Aspekte bei der Akutversorgung adressieren. Dabei sollten Standards für die Kommunikation und Interaktion zwischen Team und Patient definiert werden, die auf eine Vermeidung von Verstärkung dysfunktionaler Verhaltensweisen des Patienten abzielen. Zudem sollten Super- und Intervisionen durchgeführt werden. Ein klinisches Ethikkomitee sollte in besonders komplexen Fällen einbezogen werden. Aus ethischen, medizinischen und haftungsrechtlichen Gründen kann nicht empfohlen werden, bei wiederholten FKI pauschal auf eine Endoskopie zu verzichten. In Einzelfällen kann jedoch nach Nutzen-Risikoabwägung sowie interdisziplinärem Konsens die Gastroskopie verzögert durchgeführt oder vermieden werden, um dysfunktionale Verstärkung sowie das Risiko für unerwünschte Effekte und Komplikationen zu reduzieren. Wenn eine störungsspezifische Psychotherapie (z. B. DBT, MBT) nicht verfügbar oder durchführbar ist, sind das Festlegen des weiteren Vorgehens in einem Therapievertrag, die Durchführung von Situationsanalysen und ein Kontingenzmanagement wichtige Elemente der Behandlung. Die genannten Aspekte sollten in einem interdisziplinär konsentierten und dem Patienten kommunizierten Akutbehandlungsplan dokumentiert werden.

Abstract

Foreign body ingestion (FBI) in mental disorders is a common and often highly challenging healthcare problem. While international guidelines exist for the acute gastroenterological care of adults with FBI, the data available in the psychiatric context is very limited in terms of both quantity and quality. FBI occurs in almost all mental disorders, but is probably most common in patients with borderline personality disorder. Sharp and pointed objects, particularly large (>2.5 cm in diameter) or long (>6 cm) objects, as well as batteries, especially button cells, but also magnets, are associated with the greatest risk of FBI-related complications. Nevertheless, approximately 80% of all ingested objects are excreted in the feces without complications after 5 to 6 days. Acute psychiatric care for FBI should include a medical history regarding the type and number of foreign bodies ingested, the time of ingestion, and a physical examination focusing on general condition, abdomen, respiratory system, and vital signs. Not every ingested object needs to be removed endoscopically, which is why knowledge of gastroenterological guideline recommendations is also necessary in a psychiatric setting. In cases of repeated FBI, interdisciplinary discussions should be held to address general and case-related aspects of acute care. Standards for communication and interaction between the team and the patient should be defined with the aim of avoiding reinforcement of the patient's dysfunctional behavior. In addition, supervision and intervision should be carried out. A clinical ethics committee should be involved in particularly complex cases. For ethical, medical, and liability reasons, it cannot be recommended to refrain from endoscopy in all cases of repeated FBI. In individual cases, however, after weighing the benefits and risks and reaching an interdisciplinary consensus, gastroscopy may be delayed or avoided in order to reduce dysfunctional reinforcement and the risk of adverse effects and complications. If disorder-specific psychotherapy (e.g., DBT, MBT) is not available or feasible, important elements of treatment include defining the further course of action in a therapy contract, conducting situation analyses, and contingency management. The aspects mentioned should be documented in an acute treatment plan that has been agreed upon by an interdisciplinary team and communicated to the patient.

Schlüsselwörter

Endoskopie - Ethikkomitee - nicht-suizidales selbstverletzendes Verhalten - Borderline-Persönlichkeitsstörung

Keywords

endoscopy - ethics committee - non-suicidal self-injury - borderline personality disorder

Publication History

Received: 27 October 2025

Accepted after revision: 18 December 2025

Article published online:
13 February 2026

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