A 30-years-old male was admitted to surgical emergency department with three-day history of shortness of breath and chest discomfort. He looked healthy, but confused. According to the patient`s statement, he did not have any cronicalillneses or operation, and his medical history was ordinary. His parents told us that his behaviour changed in the last few weeks. He was afebrile with normal vitals, and no associated nausea, vomiting, or fever was present. Lung auscultation showed normal results. After the initial assessment, a chest X-ray was performed (Figure 1), which revealed large, stright edge kitchen knife in the oesophagus. After being presented with a chest X-ray, the patient showed no knowledge, or any memory whatsoever, of swallowing the knife, and even looked a bit surprised. He had firmly refused proposed endoscopic examination, initially offered by a physician. Abdominal CT showed the same, without any evidence of pneumothorax,  pneumomediastinum or pneumoperitoneum (Figure 2). After the initial assessment, and due to the size and position of the knife, it was estimated that endoscopic removal would be too risky, and was therefore decided that it would have been in the best interest of the patient to undergo surgical extraction by esophagectomy (Figures 3 and 4), and three months later esophageal reconstruction with colonic interposition.

Ingestion of foreign objects is a common clinical problem and complaint for emergency room visits. Eighty percent of all cases of ingested foreign bodies are in children [1]. Adults admitted for foreign body ingestion are frequently prisoners, psychiatric patients, patients with developmental or learning disabilities, and patients with alcohol dependence. Psychotic patients may engage in foreign-body ingestion as a result of their delusional beliefs or in response to command hallucinations [2]. Also, there are also patients with severe personality disorders who repeatedly engage in foreign-body ingestion as a form of provocative, parasuicidal behavior. One distinctive feature of this method of self-harm is that it may not be immediately apparent to the physician [3].

There is no current data regarding the incidence or prevalence of foreign body ingestion in the context of psychiatric inpatients or forensic psychiatry hospital institutions, although experience suggests that its occurrence is frequent enough to warrant future scientific investigation.