A cascade of complications: Foreign body ingestion in schizophrenia leading to surgical catastrophe and protracted ventilator dependence

Foreign body ingestion (FBI) is frequently observed in psychiatric populations, particularly patients with schizophrenia. Although most ingested objects pass spontaneously, less than 1% result in gastrointestinal perforation requiring surgical intervention. We describe a 54-year-old male with longstanding refractory schizophrenia and pica who presented with recurrent episodes of deliberate ingestion of metallic and organic objects over two decades. The patient developed concealed colonic perforations leading to peritonitis, septic shock, and prolonged ventilator dependence following multiple abdominal surgeries, including bowel resection and colostomy. His postoperative course was further complicated by restrictive lung disease, malnutrition, acute kidney injury requiring hemodialysis, enterocutaneous fistula, and recurrent bowel obstructions. This case demonstrates the severe, cascading complications of repeated FBI in schizophrenia, progressing from intestinal perforation to multi-organ failure and protracted critical illness. Recurrent FBI in psychiatric patients can culminate in catastrophic surgical outcomes and prolonged ventilatory dependence. Early recognition, prompt surgical management, and continuous psychiatric involvement are crucial. A coordinated multidisciplinary approach involving surgeons, psychiatrists, and intensivists is imperative to prevent recurrence and improve long-term outcomes in this vulnerable population.