Self-Embedding Disorder in Teens Identified by Radiologists

Minimally invasive, image-guided treatment is a safe and precise method for removal of self-inflicted foreign objects from the body, according to the first report on "self-embedding disorder,” or self-injury and self-inflicted foreign body insertion in adolescents.

"Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis, and mobilize the healthcare system for early and effective intervention and treatment,” said the study's lead investigator, William E. Shiels II, D.O., chief of the department of radiology at the Nationwide Children's Hospital (Columbus, OH, USA).

Self-injury, or self-harm, refers to a range of behaviors in which an individual intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among U.S. adolescents, especially girls. Prevalence is unknown because many cases go unreported, but recent studies have reported that 13-24% of high school students in the United States and Canada have practiced deliberate self-injury at least once. Typical forms of self-injury include hair pulling, cutting of the skin, burning, bruising, breaking bones, or swallowing toxic substances. In cases of self-embedding disorder, objects are used to puncture the skin or are embedded into the wound after cutting.

Dr. Shiels and colleagues evaluated 19 episodes of self-embedding injury in 10 adolescent girls, age 15 to 18. Using ultrasound and/or fluoroscopic guidance, interventional pediatric radiologists removed 52 embedded foreign objects from nine of the patients. The embedded objects included metal staples, metal needles, metal paperclips, glass, wood, plastic, graphite (pencil lead), crayon, and stone. The objects were embedded during injuries to the arms, ankles, feet, hands, and neck. One patient had self-embedded 11 objects, including an unfolded metal paperclip more than six inches in length.

Ultrasound guidance allowed the researchers to detect the presence and location of wood, and crayons and plastic objects not detectable on X-ray examinations. Removal was performed through small incisions in the skin that left little or no scarring and was successful in all cases, without fragmentation or complications.

"This technique offers surgeons and emergency physicians a safe and effective alternative for removal of foreign bodies, including objects at risk for fragmentation during traditional operative techniques,” said co-author Adam Young. "The small incision minimizes scarring and deformity, which is key for the self-esteem of this unique, high-risk group of patients.”

The findings were presented in December 2008 at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago, IL, USA.

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Nationwide Children's Hospital