Abstract
BACKGROUND
This study aimed to evaluate the diagnostic approaches, treatment modalities, and clinical outcomes of patients presenting to the emergency department following razor blade ingestion.
METHODS
Hospital records of patients who presented to the emergency department with razor blade ingestion and were referred to the General Surgery Clinic between 2021 and 2024 were retrospectively reviewed. Data collected included demographics, presenting symptoms, time to presentation, number of ingested razor blades, imaging findings, treatment approaches, complications, and clinical outcomes.
RESULTS
A total of 72 patients with complete medical records were included. All patients were male and incarcerated. The mean age was 31.2 years, and the mean time to presentation was 8 hours. The mean number of ingested razor blades was 1.4. Endoscopic intervention was performed in seven patients (10%) in whom imaging localized the razor blade to the stomach; all presented within 6 hours of ingestion. Successful endoscopic removal was achieved in two patients, while no razor blade was visualized in the stomach in five patients. Surgical intervention was required in two patients (3%). A total of 63 patients (87%) recovered without intervention with outpatient conservative management and follow-up. Successful endoscopic removal was achieved in patients who presented within the first 2 hours. No morbidity or mortality was observed.
CONCLUSION
A conservative management is safe and effective in most cases of razor blade ingestion. Early endoscopy may decrease the likelihood of surgical intervention.
Keywords: Razor blade ingestion, foreign body, surgery, endoscopy, prisoner
Abstract
AMAÇ
Bu çalışmada, jilet yutma nedeniyle acil servise başvuran hastaların tanısı, uygulanan tedavi yöntemleri ve klinik sonuçlarının ayrıntılı olarak değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM
2021-2024 yılları arasında jilet yutma nedeniyle acil servise başvuran ve Genel Cerrahi Kliniği’ne konsülte edilen hastaların hastane kayıt sistemindeki verileri retrospektif olarak incelendi. Şikayetler, demografik veriler, başvuru süreleri, yutulan jilet sayısı, yapılan tetkikler, görüntüleme bulguları, uygulanan tedavi yöntemleri, gelişen komplikasyonlar ve sonuçlar değerlendirildi. Çalışma tek merkezli, gözlemsel ve tanımlayıcı nitelikte planlandı.
BULGULAR
Çalışmaya kayıtlarına eksiksiz ulaşılan toplam 72 hasta dahil edildi. Tüm hastalar erkek ve mahkumdu. Ortalama yaş 31.2 yıl, ortalama başvuru süresi 8 saat ve ortalama yutulan jilet sayısı 1.4 idi. Görüntülemelerde jiletin mide seviyesinde izlendiği 7 (%10; bu hastaların tamamı ilk 6 saat içinde acile başvuran olgulardı) hastaya endoskopi yapıldı. İki hastada jilet ve/veya jiletler endoskopik olarak başarıyla çıkarıldı, beş hastada ise mide içinde jilet saptanamadı. Cerrahi girişim 2 (%3) hastada başarıyla uygulanırken, 63 (%87) hasta ayaktan konservatif gözlem ve düzenli kontrole çağrılarak herhangi bir girişim yapılmadan düzeldi. Endoskopi ile başarılı şekilde jilet çıkarılan hastalar, ilk 2 saat içinde başvuran olgulardı. Hiçbir hastada morbidite veya mortalite gelişmedi.
SONUÇ
Jilet yutma olgularında konservatif yaklaşım çoğu zaman güvenli ve etkilidir. Uygun seçilmiş hastalarda erken dönemde endoskopi denenebilir ve bu yaklaşım cerrahi gereksinimini anlamlı düzeyde azaltabilir. Elde edilen bulgular, özellikle mahkum popülasyonunda yabancı cisim yönetimine yönelik klinik algoritmaların şekillenmesine katkı sağlayabilir.
Keywords: Anahtar sözcükler: Cerrahi, endoskopi, jilet yutma, mahkum, yabancı cisim
INTRODUCTION
Foreign body ingestion is relatively uncommon in the general adult population but represents a significant clinical concern among incarcerated individuals and patients with psychiatric disorders.[1,2] Razor blade ingestion, in particular, can lead to serious gastrointestinal complications due to its sharp, cutting nature.[3]
The majority of ingested foreign bodies (80–90%) pass spontaneously through the gastrointestinal tract without the need for intervention. Objects that reach the stomach typically pass within 3–4 days. However, objects larger than 2 cm in diameter may fail to pass through the pylorus or ileocecal valve, while those longer than 5 cm may have difficulty traversing the duodenum.
Current guidelines recommend urgent endoscopic intervention (within 24 hours) in the following situations:[4]
Sharp-pointed objects in the stomach or duodenum (e.g., razor blades),
Objects larger than 5 cm located in the proximal duodenum,
Magnets and batteries accessible to endoscopic retrieval.
Although sharp objects that reach the stomach often pass without incident, complications have been reported in up to 15–35% of cases.[5] Therefore, the literature generally recommends endoscopic removal of sharp or penetrating foreign bodies whenever feasible.[6]
In this study, we evaluated the clinical characteristics, management strategies, and outcomes of patients presenting with razor blade ingestion.
MATERIALS AND METHODS
Hospital records of patients who presented to the emergency department with razor blade ingestion and were referred to the General Surgery Clinic between 2021 and 2024 were retrospectively reviewed. Data collected included presenting symptoms, demographic characteristics, time to presentation, number of ingested razor blades, imaging findings, treatment modalities, complications, and clinical outcomes.
The following variables were analyzed: age, sex, time to presentation, number of ingested razor blades, physical examination findings, number of admissions, imaging results (abdominal X-ray and computed tomography [CT]), treatment approaches (conservative management, endoscopic intervention, or surgery), and complications. Statistical analyses were performed using IBM SPSS, version 25.0 (IBM Corp., NY, USA). Continuous variables were expressed as mean ± standard deviation, and categorical variables as percentages. Group comparisons were performed using the Mann–Whitney U test, Spearman correlation analysis, and Fisher’s exact test. A p value of <0.05 was considered statistically significant.
Ethical approval for the study was obtained from the Aksaray University Health Sciences Scientific Research Ethics Committee (decision no. 2025/151).
RESULTS
A total of 72 patients with complete medical records were included in the study. All patients were male prisoners. The mean age was 31.2 years (range, 21–43 years), the mean time to presentation was 8 hours (range, 2–24 hours), the mean number of ingested razor blades was 1.4 (range, 1–4), and the mean number of admissions was 3.7 (range, 1–6) (Table 1, Fig. 1).
Table 1.
Demographic characteristics of the patients
| Variable | Value |
|---|---|
| Total number of patients | 72 |
| Male patients | 72 (100%) |
| Female patients | 0 |
| Mean age (years) | 31.2±6.5 |
| Time to presentation, mean (hours) | 8 (2–24) |
| Number of admissions, mean | 3.7 (1–6) |
| Patients undergoing endoscopy | 7 (9.7%) |
| Successful endoscopic removal of razor blades | 2 (2.8%) |
| Patients undergoing surgery | 2 (2.8%) |
| Mortality | 0 |
| Morbidity | 0 |
Figure 1.
Appearance of a razor blade (2×4 cm) on standing direct abdominal radiography.
Physical examination findings were unremarkable in 68 patients (94%). Rectal bleeding was observed in two patients, and abdominal pain in two patients. A radiopaque image consistent with a razor blade was detected on abdominal radiography in 70 patients, whereas plain radiography was normal in the remaining two patients. CT was performed in these two patients, as well as in an additional 18 patients, to accurately localize the foreign body (Fig. 2).
Figure 2.
Distribution of patients according to management approach (endoscopic intervention, surgical treatment, and conservative management).
Among the 20 patients who underwent CT, a radiopaque foreign body was detected outside the stomach in 19 patients. No pathological CT findings, such as perforation, free air, or abscess, were observed. In one patient, the razor blade was located in the duodenum, with associated edema on CT.
Endoscopy was performed in seven patients (10%) in whom imaging demonstrated a razor blade at the gastric level on X-ray or CT; all had presented within 6 hours of ingestion. Successful endoscopic removal was achieved in two patients. In the remaining five patients, adequate gastric visualization was not possible due to retained food and technical limitations, and the razor blade could not be identified. Notably, successful endoscopic removal occurred only in patients who presented within the first 2 hours.
Surgical intervention was required in two patients (3%): one due to the development of an acute abdomen and the other due to failed endoscopic retrieval. In both cases, gastrotomy was performed, and the foreign body was removed from the first part of the duodenum. No perforation was observed, and no postoperative morbidity or mortality occurred.
Conservative management was applied in 68 patients. These patients were followed at three-day intervals (range, 1–4 visits) with physical examination and standing abdominal radiography. At the final follow-up, all patients had normal clinical and radiological findings.
No significant difference was found between patients undergoing endoscopic and surgical management in terms of morbidity (bleeding or perforation) or mortality (p=1.0).
As age increased, a longer time to presentation was observed (p=0.0038), indicating that younger patients tended to present earlier.
A significant association was also found between age and the number of admissions (p=0.039), with older patients having fewer admissions.
In patients who did not require hospitalization, the need for surgical intervention was statistically lower (p=0.039).
No significant association was found between the number of ingested razor blades (range, 1–4) and the need for endoscopic or surgical intervention (p=0.32) (Table 2).
Table 2.
Statistical analyses and corresponding p-values
| Comparison | Statistical test | p-value |
|---|---|---|
| Age vs. time to presentation | Spearman correlation analysis | 0.0038 |
| Age vs. number of admissions | Spearman correlation analysis | 0.0390 |
| Hospitalization vs. need for surgery | Fisher’s exact test | <0.001 |
| Number of ingested razor blades vs. endoscopy | Mann–Whitney U test | 0.3200 |
| Number of ingested razor blades vs. surgery | Mann–Whitney U test | 0.3200 |
| Time to presentation vs. surgery | Mann–Whitney U test | 0.0970 |
| Time to presentation vs. endoscopy | Mann–Whitney U test | 0.4100 |
DISCUSSION
In this study, we evaluated the clinical characteristics, management strategies, and outcomes of 72 patients presenting with razor blade ingestion. The fact that all patients were male prisoners is consistent with previous reports in the literature.[1,2,7] Razor blade ingestion has been shown to be more common in incarcerated populations and is often associated with secondary gain and underlying psychiatric disorders.[7] In our cohort, some patients were diagnosed with antisocial personality disorder. However, as many patients declined psychiatric evaluation and treatment, detailed psychiatric data were not available. Further studies are needed to more comprehensively assess psychiatric diagnoses in this population.
Endoscopy is widely recommended as the first-line approach for the removal of sharp foreign bodies from the gastrointestinal tract.[3,7–9] The absence of complications among patients who underwent endoscopy in our study supports its safety. However, previous studies have reported that endoscopic removal of sharp objects may carry a risk of bleeding or perforation.[11] For this reason, conservative management was preferred in the majority of our patients (68; 94%).
The success rate of endoscopy in our series was 28.5% (2/7 patients), which is lower than the 30–90% reported in the literature.[10,12,13] This discrepancy may be explained by delayed presentation in our patient population, resulting in migration of the razor blades to the small intestine rather than remaining in the stomach at the time of imaging. Prolonged time to presentation is a key factor reducing the success of endoscopic intervention. Considering both delayed presentation and the potential risk of esophageal injury during endoscopic retrieval of the razor blade, conservative treatment may be safely applied.
The reported need for surgery ranges from 5% to 15% in the literature.[8,14,15] In our series, this rate was lower (3%). Higher surgical rates reported in previous studies may be related to the inclusion of patients undergoing surgery not only for acute abdomen but also following failed endoscopic attempts in cases of sharp object ingestion. Increasing the use of conservative follow-up may reduce the need for both endoscopy and surgery.
In our study, no morbidity or mortality was observed. In contrast, morbidity rates ranging from 0% to 22% have been reported in the literature.[16,17] This finding suggests that a conservative approach can be safely applied in appropriately selected patients.[18]
No statistically significant relationship was found between the number of ingested razor blades and the need for endoscopic or surgical intervention, suggesting that the number of ingested objects alone does not determine management. In contrast, significant associations were observed between age and time to presentation, and between age and the number of admissions. Younger patients had more frequent admissions and presented earlier, which may be related to a greater tendency for secondary gain in this population.
Endoscopy was performed in seven patients who presented within the first 6 hours. In two patients who underwent endoscopy within the first 2 hours, the razor blade was successfully removed, whereas in the remaining five patients, removal was unsuccessful. At presentation, imaging studies showed that the razor blade was located beyond the esophagus and stomach in many patients. In the absence of acute abdomen findings during follow-up, 68 patients were managed conservatively. As the majority of patients in our clinic were managed conservatively, the number of patients who underwent endoscopy was insufficient to robustly evaluate endoscopic success.
No morbidity (bleeding or perforation) or mortality was observed in patients managed conservatively. Therefore, patients with normal physical examination and imaging findings may be safely followed without endoscopic intervention.
The main limitations of this study include its retrospective design, single-center setting, and the inclusion of only incarcerated patients. However, this study represents one of the largest series on this topic in Türkiye and provides contemporary data.
CONCLUSION
Contrary to common reports in the literature, most patients with razor blade ingestion can be safely managed conservatively without endoscopy. Although endoscopy is a safe and effective treatment modality, it may be reserved for selected patients. Multicenter, prospective studies with larger sample sizes are needed to better define optimal management strategies.
Footnotes
Cite this article as: Bayraktar YA, Gemici K. Management of patients who ingest razor blades: a single-center experience. Ulus Travma Acil Cerrahi Derg 2026;32:789-793.
Ethics Committee Approval
This study was approved by The Aksaray University Health Sciences Scientific Research Ethics Committee (Decision No: 2025/151).
Peer-review
Externally peer-reviewed.
Authorship Contributions
Concept: Y.A.B.; Design: Y.A.B.; Supervision: Y.A.B.; Resource: K.G.; Materials: K.G.; Data Collection and/or Processing: K.G.; Analysis and/or Interpretation: K.G.; Literature Search: Y.A.B.; Writing: Y.A.B.; Critical Reviews: Y.A.B.
Informed Consent
Written informed consents were obtained from patients who participated in this study.
Conflict of Interest
The author declare that there is no conflict of interest.
Financial Disclosure
The author declared that this study has received no financial support.
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