Where’s the rest of it?

I pick up the chart of a man in his early forties. “Rectal pain” is the chief complaint.

When I enter the room, the patient is standing in the corner, dressed in a hospital gown and looking rather glum. I introduce myself and ask how I can help him. He mumbles enough of a non-specific answer for me to understand he has something stuck in his rectum that he can’t get out.

I invite him to bend over the exam table as I turn to get some gloves.

Turning back to him, gloves on hands, I pull the gown away from his backside. Sticking out of his anus is the end of a broomstick about a foot long. This surprises me somewhat. I touch it and the patient moans in pain.

“How long has this been in there?” I ask.

“Mmmmm. Four days,” is the reply.

I explain to the patient that we clearly need to give him pain medicine and also something to help him relax before trying to get the stick out. I then excuse myself and pass orders on to the nurse to get this started.

Once the patient is medicated, I return to the room and, again, don gloves. This time, the patient is comfortable enough that he only moans as I pull the stick out. Interesting. The other end of the stick is wrapped in twine. I’m trying to figure this out when the patient looks up at the stick and groggily asks, “Where’s the rest of it?”

An x-ray reveals the outline of a large, penis-shaped dildo stuck in the patient’s rectum. Now, I think I understand what happened. The patient wanted to get the dildo farther into his rectum, so he put it on the end of a broomstick. However, the broomstick was smaller than the inside of the hollow dildo so he wrapped the stick with twine until it fit snuggly inside the dildo and would not come off.

What he failed to consider was what would happen when the dildo was all the way up inside his rectum. Once his anus closed down over the dildo onto the broomstick, it was stuck and couldn’t be pulled back out again.

The poor guy, too embarrassed to seek help, had been sitting – or not sitting – around the house for four days, in miserable discomfort, with that thing stuck in there.

I will blog more in the future on rectal foreign bodies as it is a recurrent and interesting subject in the emergency department. Sometimes, we are able to get them out in the ED. Other times, as in this case, we are unable to do so. In those situations, we call the surgeons. With the patient asleep, and with access to tools they have in the operating room, the surgeons are often able to pull the object out. But, not always. Sometimes, as in this case, the surgeon actually has to cut the abdomen open for removal.

Please don’t ask me why people do this. I never ask. You will just have to use your imagination or go online for more specific information.