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Foreign Body Insertions: A Review

Treating patients who present with foreign body insertions requires a nonjudgmental and open-minded approach.
Emergency Medicine. 2017 July;49(7):315-319 | 10.12788/emed.2017.0040
July 5, 2017|Emergency Medicine
Alan Lucerna, DO
Author and Disclosure Information

Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.

Anorectal and urethral foreign body insertions (polyembolokoilamania) are not infrequent presentations to the ED. The motivations behind these insertions vary, ranging from autoeroticism to reckless behavior. These insertions can lead to major complications and even death. Though ED staff members are used to the unpredictability of human behavior, foreign body insertions bring a mixture of responses from the staff, ranging from awe and incredulousness to anger and frustration. A knowledge and comfort in managing these cases includes a nonjudgmental triage assessment, collective professionalism, and self-awareness of the staff’s reaction.

Case 1

A 58-year-old man presented to the ED for evaluation of a foreign body in his rectum. He admitted to placing a beer bottle in his rectum, but was unable to remove it at home. The staff reported that the patient was previously seen in the ED for removal of a vibrator from his rectum.

Radiographic evaluation in the form of an acute abdominal series was obtained and confirmed a beer bottle in the rectum (Figures 1 and 2).

Figure 1.
This study was performed prior to the rectal examination to evaluate the orientation and integrity of the item, to prevent accidental injury from sharp objects.
Figure 2.
On examination, there was palpable glass in the rectum consistent with the rounded base of a bottle. The glass appeared intact and no gross bleeding was noted. Given the orientation of the bottle on the X-ray image, a surgical consultation was obtained and the patient was taken to the operating room (OR). The foreign body was successfully removed with manual extraction under general anesthesia. The patient did not experience any complications. He was offered psychiatric counseling in the ED, but he declined. He was discharged home with a referral to a psychiatrist for counseling.

Case 2

A 55-year-old man presented to the ED after he inserted a pen cap into his urethra to aid in obtaining an erection. A pelvic X-ray was obtained and showed a radiolucent structure in the penis (Figure 3).

The patient had been seen in several different hospital EDs more than 20 times with similar presentations of penile foreign body insertion.

Figure 4.
The various items inserted included a dry wall screw (Figures 4 and 5) and ballpoint pen (Figure 6). The patient suffered from erectile dysfunction and had been offered multiple treatment options, ranging from medications to penile implant, but he refused these treatments.

The patient was admitted to the hospital and taken to the OR by the consulting urologist. Using a rigid cystoscope and flexible graspers, the pen cap was removed from the proximal urethra under monitored anesthesia control. The procedure went without any complications.

A psychiatrist was consulted, and during the encounter, the patient admitted that his behavior was pathological. He revealed that he was a victim of child abuse and reported he had been having mixed emotions of anxiety, guilt, and embarrassment because of his behavior.

Figure 5.
He consented to inpatient psychiatric treatment and was subsequently transferred to a psychiatric facility.

Discussion

Foreign body insertions are seen in patients with a wide variety of backgrounds, ages, and lifestyles. Approximately 80,000 cases of foreign body ingestion are seen annually in children under age 20 years. Young males have a higher predilection of swallowing foreign bodies when compared to young females,1 and rectal foreign body insertions are seen more commonly in males than in females.2 In this age group, intentional foreign body insertion may be an initial manifestation of psychiatric illness.

Figure 6.
It may also reflect risk-taking or attention-seeking behavior, or poor judgment—especially when combined with alcohol or drugs. Many of those who are evaluated for foreign object insertion have a history of similar prior presentation.1 In comparison, there is a much lower incidence for lower urinary tract foreign body insertions, and self-inflicted urethral foreign body insertions are considered rare, and much rarer in children.3-5 Information on the actual prevalence of foreign object insertions in the general population or in specific psychiatric populations, however, is lacking.1

Rectal Insertions

The earliest published report of a rectal foreign body insertion was in 1919 by Smiley.6 The typical age at presentation ranges from 20 to 90 years old, with a mean age of 44 years old.2 Household objects such as bottles and glasses are the most commonly seen, but a long list of other items have also been reported in the literature, including toothbrushes, knives, deodorant bottles, food articles, sports equipment, cell phones, flashlights, wooden rods, broomsticks, sex toys, light bulbs, construction tools, nails, ornaments, aerosol canisters, cocaine packets, jewelry, batteries, guitar picks, and many other items.1,2,7

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