A 36-year-old single unemployed man who was first diagnosed with schizophrenia by a psychiatrist about 12 years ago is described here.\nHe remained in school until the eighth grade, when his abnormal behaviors at school caused him to stop his education. Also, for the same reason, he was fired from his job 2 years ago. He has been smoking cigarettes since 12years ago, and he started to smoke opium 11 years ago.\nHe did not have any evidence of brain damage or any major medical illnesses. He was the second child in a family of 6 with low socio-economic status. His parents were consanguineous and had no physical or mental abnormalities, although one of his younger brothers suffered from mental retardation. During the 12 years of his disease, he has been treated in both outpatient and inpatient settings. Due to exacerbation of his symptoms, he was admitted to a psychiatric ward on 4 occasions, and the course of his illness shows a fluctuating clinical picture. Since his first disease symptoms, he was diagnosed with personality disorder (borderline type), bipolar disorder, and even factitious disorder. His compliance with taking the prescribed medications and attending follow-ups has been very poor.\nDuring the initial phase of his illness, he had prominent positive features, occasional violent outbursts, and delusions of persecution regarding his family and neighbors. All of his hospital admissions were due to psychotic exacerbations, which initially manifested as violent behavior and aggression towards others and then progressed to delusions of persecution, delusions of reference, and both auditory and visual hallucinations. During this phase of his disease, he was diagnosed with schizophrenia. He had a good appetite, but was suffering from early and terminal insomnia. He also had a history of self-mutilation from about ten years ago, but at the time of visit had no suicidal or homicidal thoughts or plans. His initial treatment plan included Valproic acid 200mg tablets TID (600 mg/day) and an Olanzapine tablet 5mg per day. Two years ago, this regimen was changed by his psychiatrist to Haloperidol 5 mg BID (10 mg/day), Biperiden 2 mg/day, Clonazepam 1 mg/day, Citalopram 20mg BID (40 mg/day), and Propranolol 10mg BID (20 mg/day) prescribed as oral medication. During his hospital admissions, he made steady recoveries, but his follow-ups and compliance were poor. All of his laboratory work-ups and brain computed tomography scans (CT scans) were normal and his electroencephalograms (EEG) showed no abnormalities.\nDuring his fourth and last admission, he was brought to the emergency department because of severe abdominal pain. He had abdominal tenderness in his physical examination and his vital signs were stable. His abdominal X-ray revealed the ingestion of a metallic skewer that was broken apart (). After surgical consultation, endoscopic removal of the objects was suggested, but about an hour later the patient became medically unstable and had a board-like abdomen in his examination. After a second evaluation by a surgical team, the patient was diagnosed with intestinal perforation and an emergency exploratory laparotomy with enterotomy was performed. The surgery was without complications, and metallic items were removed from the patient’s abdomen. He had an uneventful postoperative recovery.\nAfter his recovery, at the subsequent psychiatric follow-up visit, he explained his motive for ingesting the metallic skewer and revealed that a demon that had been living inside his body had been controlling him for the previous three months. He insisted that the demon wouldn’t let him tell the psychiatrists about its existence and wanted to control and use his soul to destroy the world. He believed that he could fight and kill the demon by ingesting the metallic skewer.\nTwo weeks after abdominal surgery, the patient attended our psychiatry outpatient clinic twice. He continued to have delusions of persecution and reference; however, he was convinced that because the surgery involved opening his abdomen, the demon had left his body and there was no need to fight with him anymore. Due to close monitoring by his family members, he did not ingest any further non-food items. Also, this close monitoring helped him have better compliance with his psychiatric visits and therapies.
A 50-year-old male presented at the General Surgery Polyclinic due to increased complaints of swelling and intermittent pain in the neck which had been ongoing for 6 years. On the neck ultrasound imaging, heterogeneous nodules were observed in the parenchyma of 27 × 19 mm in the right lobe and 20 × 16 mm in the left lobe and central anechoic cystic nodules 40 × 18 mm at the isthmus level extending towards the lumen. Thyroid function tests were normal and the patient was diagnosed with multinodular goitre. The patient had no comorbid disease and after premedication was admitted to the operating room for elective surgery. Monitorization was applied on the operating table: TA: 130/85 mmHg, pulse: 75 bpm, SpO2: 99%. Sedation was administered by 2 mg midazolam, then anaesthesia induction was made with 2-3 mg/kg propofol, 100 mcg fentanyl, and 0.6 mg/kg rocuronium. After mask ventilation for 3-5 mins, the patient was intubated with no problems. No hemodynamic or respiratory problems were experienced in the intraoperative period. The surgery lasted 1 hr and 45 mins, after which the patient was awakened with no problems and was transferred to the postoperative anaesthesia care unit (PACU). When the patient was fully awake, he was experiencing chest pain and complained that dentures were not in place in his mouth, so a posterior-anterior pulmonary radiograph was taken and a standing direct abdominal radiograph. The dentures were observed in the stomach (). In the history taken from the patient, it was seen that when going to the operating room, partial fixed dentures were in place, and he stated they were in his mouth until reaching the operating room. The emergency gastroenterologist was consulted, and the patient was evaluated but as he had already eaten food, endoscopy procedures were postponed until the following day. In the upper gastrointestinal endoscopy applied the following day, despite having passed the ligament of Treitz, the dentures could not be visualized. On the standing direct abdominal radiograph, the dentures were seen to be in the jejunum (). The abdominal examination was comfortable for the patient, so it was decided to continue medical follow-up. A standing direct abdominal radiograph was taken daily (), and on the radiograph taken on the 5th day, the dentures could not be seen (). The patient was questioned. The dentures had been expelled during bowel evacuation, but the patient did not recall anything other than a slight pain during evacuation.