Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies

A retrospective review of the circumstances and characteristics of 72 adult autoerotic neck compression deaths in Australia, between 2000 and 2022

Autoerotic asphyxial deaths are a rare but recurring phenomenon, the most common modality of which involves neck compression. Autoerotic neck compression can involve any compression to the neck during individual sexual activity performed to heighten arousal. This retrospective study examines 72 such deaths occurring in Australia between 2000 and 2022. The study aims to provide detailed medico-legal interpretation of such deaths and recommendations for investigation within Australian contexts, and globally. Demographic analysis reveals a predominance of Caucasian males under 50 years of age, with diverse employment and health status. Pathological examination uncovers a spectrum of injuries, from superficial abrasions to rare skeletal and cartilaginous injuries, providing insights into the mechanics and characteristics of these fatalities. Contextual examination highlights sexual paraphernalia, evidence of genital stimulation, and isolation are consistent features in most autoerotic deaths within the sample. There was a wide variety of tool usage (ropes, belts, etc.), and geo-temporal features associated with autoerotic neck compression. The study provides comprehensive examination of the circumstances and characteristics of autoerotic neck compression which may assist in differentiation between suicidal and homicidal neck compression deaths such as hanging or ligature strangulation respectively. This study is an Australian first and is the first study of autoerotic asphyxial deaths to focus solely on deaths with a neck compression component. The study incorporates new variables and suggests ways these should be considered in future death investigations. The authors argue for delineation and subcategorization of autoerotic neck compression from other autoerotic asphyxial death due to their distinct injury characteristics and mechanism of injury.

Magnetic beads as intravesical foreign bodies in children: our clinical experience

Purpose

To analyze the clinical data of five patients involving intravesical magnetic beads, summarizing diagnostic and therapeutic experiences.

Methods

From January 2018 to November 2023, five pediatric patients were treated for intravesical magnetic beads at Shenzhen Children's Hospital. We retrospectively reviewed and analyzed the records of these patients, including demographic characteristics, clinical symptoms, imaging studies, and treatment methods.

Results

All intravesical magnetic beads were retrieved from patients' bladders. The patients ranged from 12 to 14 years, with a mean age of 13 years. None of them had a history of psychiatric disorders. Depending on the number of magnetic beads, their aggregation state, and the time since insertion, Three cases were successfully retrieved via cystoscopy, one via pneumovesicoscopy, and another via open surgery. No complications were observed during the postoperative follow-up.

Conclusion

Magnetic beads are a relatively rare type of intravesical foreign bodies and should be surgically removed as soon as possible. Cystoscopy is the first method for both diagnosis and treatment. When magnetic beads cannot be retrieved via cystoscopy, pneumovesicoscopy may be a viable option for the retrieval of foreign bodies. When endoscopic techniques are unsuitable or have failed, open surgery is a necessary option.

Probing the Matter: A Case of Rectal Foreign Body Insertion in a Patient With Intellectual Disability

Rectal foreign body insertion presents a challenging clinical scenario, with increasing incidence, particularly among males. In both acute management and long-term care, particularly when associated with psychiatric illness or intellectual disability, careful consideration is required. We report a 23-year-old male with mild intellectual disability who presented with a retained handheld bidet shower inserted for sexual gratification. He had a similar episode within the past six months. Despite the object being partially visible externally - that may cause the inexperienced, unassuming physician to falsely believe the ease of removal - it is imperative to follow proper diagnostic and management protocols for safe retrieval. Initial evaluation included radiographic assessment by X-ray imaging to determine the object's position and rule out complications. Successful transanal extraction was achieved without complications under general anesthesia. Postoperative CT with rectal contrast confirmed the absence of perforation or lingering damage related to the foreign body or procedure. The patient was subsequently referred for psychiatric evaluation and started on olanzapine but was later lost to follow-up. This case highlights the importance of systematic management protocols in rectal foreign body extraction, regardless of the apparent simplicity of retrieval. It also emphasizes the need for comprehensive psychiatric evaluation and follow-up care, particularly in patients with intellectual disability, while addressing the persistent social stigma surrounding both rectal foreign body insertion and mental health issues.

An Act of Auto-Eroticism: Self-Urethral Insertion of Sewing Needle by an Old Man-A Case Report With Literature Review

Self-insertion of foreign bodies into the urethra is uncommon and is often associated with complex psychological or behavioral factors. Many cases of foreign bodies in the urethra have been reported worldwide with variable complaints of penile pain, penile itching, dysuria, hematuria, and complete obstruction of urine. These foreign objects are managed to remove according to their size, complexity of shape, and location in the urethra. We report a case of a self-inserted sewing needle in the urethra by an old man during an act of achieving sexual gratification, which was removed through an endoscopic approach by cystoscopy, along with a literature review. This is the fourth reported case of auto-eroticism in which a sewing needle was used to achieve sexual pleasure, making this case report a rare one.

No Right Way: Removal of a Pencil Foreign Body From a Male Urethra

Foreign body insertion into the urethra is uncommonly encountered in urology practice. Such insertion can result in a myriad of problems including bleeding, infectious sequelae, urinary retention, urethral injury or rupture, and resultant urethral stricture formation. This article describes a case in which an elderly male inserted a pencil into his urethra, which subsequently became lodged and required removal under regional anesthesia in the operating theater. The foreign body resulted in urethral damage in the form of a false passage within the bulbomembranous urethra. The pencil was removed with forceps, followed by undertaking a check rigid ureteroscopy and cystoscopy before placement of a urethral catheter via a guidewire. Postoperatively, the patient developed urinary sepsis requiring an extended course of intravenous antibiotics. The catheter was left in situ for six weeks before removal to allow satisfactory urethral healing.

Few incidentally found interesting foreign objects in human body: a case series

Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.

Self-filling of male urethra with silicon jell to achieve erection: A case report

Self-insertion of foreign body into male urethra represents heterogeneous group of cases in terms of causes, symptoms and management. We reported a case of 60-year old male patient filled his urethra with silicone-jell. Patient had severe penile pain and difficult urination. Physical examination revealed palpable hard mass starting from distal part of prostatic urethra to midpenile urethra. Rigid cystoscopy showed complete occlusion of urethra. Laser fragmentation and mechanic extraction failed. Open surgery was decided. Midline incision was performed at the distal end of foreign body in the penile urethra. The foreign material was extracted successfully.

Polyembolokoilamania with obsessive compulsive and related disorders: A case series

Polyembolokoilamania is a condition seen in a medical or surgical emergencies where the person, sometimes repetitively, inserts various foreign bodies through body orifices or skin to obtain gratification often associated with background psychiatric diagnoses. We present three cases where one patient with Obsessive Compulsive Disorder (OCD) presented with urethral polyembolokoilamania, one with Excoriation disorder presented with multiple pin-piercing behavior through the skin and one case of OCD presented with anal polyembolokoilamania. Treatment of the underlying Obsessive-Compulsive and Related Disorders curbed such behaviors successfully in all three cases emphasizing the importance of treating background psychiatric disorders in such conditions.

Should Psychiatry Be Consulted When Facing a Self-Inflicted Foreign Body in the Urinary Tract?

Background

On encountering a self-inflicted foreign body in the urinary tract, it is common that emergency physicians only consult the department of urology, and no further evaluations from other specialties are sought. Psychological conditions can also involve people with psychiatric disorders who perform self-harming or sexual practices. Many case reports of foreign bodies have been reported in the literature. However, there is little information regarding which specialties to consult in this situation within the emergency department (ED).

Methodology

This case series study gathered information on 10 cases from patients who attended the ED from 2005 to 2020 with the diagnosis of genital or lower urinary tract foreign body.

Results

In total, 10 patients were analyzed with a mean age of 37.3 (SD: ±14.1) years. Of the 10 patients, seven (70%) were males, and three (30%) were females. Overall, four (40%) patients presented with lower urinary tract symptoms (dysuria, tenesmus, hematuria, urinary frequency), five (50%) patients had a significant psychiatric history, and eight (80%) patients admitted having these practices for sexual gratification.

Conclusions

Foreign bodies in the lower urinary tract pose a significant challenge to ED physicians and urologists because some patients do not admit or do not recall inserting foreign bodies. Patients should be interrogated for mental illness, medication use, and a history of foreign bodies in the urinary tract or genitals during the initial evaluation. There is no consensus or screening method for such patients presenting to the ED. Hence, the use of complementary imaging studies and cystoscopy is fundamental for diagnosis. Further, it is essential to perform a psychiatric evaluation to diagnose or address any underlying psychiatric conditions that could cause this behavior.

Pneumoperitoneum in Rectal Polyembolokoilamania

Foreign body insertion in the rectum is not a very common presentation in the emergency department but this is common among individuals with a history of self-harm, personality disorders, and other psychosomatic illnesses. It is often diagnosed on abdominal x-rays; however, a CT scan of the abdomen and pelvis may be warranted when perforation is suspected. To diagnose an anorectal foreign body, clinicians must maintain a high level of suspicion. Because of embarrassment or maybe psychological concerns, the patient may not be ready to share all the information. Healthcare providers must hence show empathy and compassion while being calm and non-judgmental. Here, we present a case of an 80-year-old male who underwent a laparotomy for removal of a large foreign body that was inserted in the rectum and caused a gastrointestinal perforation.

Vaginal foreign body insertion in a patient with emotionally unstable personality disorder

Insertion of foreign objects into one or more bodily orifice, otherwise known as polyembolokoilamania, occurs as a result of a variety of psychosocial and psychiatric states. Such behaviour exposes the affected individual to the complications of object insertion, surgical removal and its adverse sequelae such as a colovesical fistula. Foreign body insertion into the vagina mainly involves children and can be associated with premenarchal vaginal discharge or sexual abuse. The gynaecological literature describes cases involving adults and can be associated with drug smuggling or sexual gratification. Commonly retrieved foreign bodies from the vagina includes tampons, hair pins, buttons, seeds, toy parts, objects used in foreplay, forgotten pessaries, pen caps, toilet tissue and illicit drugs for trafficking. There is a relative dearth of cases reported in the psychiatric literature. Management of deliberate foreign body insertion [DFBI) in borderline personality disorder patients is challenging, often repetitive and the potential for further self-harm and complex emotional issues may elicit strong countertransference from medical staff. Although there are well-established guidelines for acute medical and surgical management of DFBI, none provide an overview of the management of repeat presentations or consider the role of secondary gain or provide reinforcement strategies for managing this complex patient cohort. The authors present the case of a 23-year-old woman with an emotionally unstable personality disorder presenting to the emergency department after inserting objects in her vagina. This paper will provide an overview of the presentation, investigations and management of individuals presenting after inserting foreign objects into the vagina. In the majority of cases, a carefully obtained history and physical examination will render the diagnosis, although imaging modalities may be required to locate the misplaced objects. Individuals may present with bleeding, blood stained or foul-smelling vaginal discharge. Prompt management can prevent morbidity and mortality resulting from complications.

Case Report: Using Point-of-care Ultrasound as a Tool to Identify a Urethral Foreign Body

Introduction

When patients present to the emergency department with retained urethral foreign objects, imaging is crucial for identifying and further describing the object(s). Imaging is also important to plan the management and to assess the potential complications of foreign object removal. Ultrasonography is sometimes used for this purpose and can often provide more information on the object and its location and characteristics than plain radiographs.

Case Report

This case report discusses the identification and characterization of a retained urethral foreign object that was not seen on plain radiography.

Conclusion

While ultrasonography has its own limitations, in the cases of retained foreign objects, it can provide preferable imaging and can help guide the management of these patients.

Superglue self-insertion into the male urethra - A rare case report

Background:

Foreign body insertion in the urethra and bladder are relatively rare. These patients usually insert foreign body in urethra for eroticism, inquisitiveness, or as a consequence of disinhibited or disturbed behavior.

Case presentation:

Herein, we report a case of 41-year-old man presented with weak stream and suprapubic pain. Due to incontinence, he instilled superglue into his urethra. On perineal examination, a foreign body was palpable in the penile urethra. A 10 cm dried superglue block got out with incision at glance.

Conclusion:

Urethral foreign bodies are mostly found on physical examination and clinical history. Although imaging modalities are commonly used for FBs detection, the necessity of imaging modalities are still a controversy.

Foreign body urethra misdiagnosed as stricture leading to inadequate management and prolonged treatment duration: a lesson to learn

Misdiagnosis of a urethral foreign body (FB) as urethral stricture leads to inadequate management and prolonged treatment duration. A 55-year-old male patient was referred with complaints of difficulty in voiding and poor urinary stream for 2 months. He initially presented at a primary healthcare centre and was misdiagnosed as urethral stricture and was scheduled for urethroplasty. Surprisingly, intraoperative cystourethroscopy performed by us revealed that the urethra had been obstructed by an FB. The FB was gently pushed into the bladder and retrieved. The postoperative course was uneventful. The present case represents a rare occurrence of polyembolokoilamania or insertion of a FB into any bodily orifice for sexual gratification.

Result of Health Illiteracy and Cultural Stigma: Fournier's Gangrene, a Urological Emergency

A 63-year-old Caucasian man presents to his regional hospital 8 days postinsertion of beads in his urethra, causing Fournier's gangrene of the penis and delayed surgical management of his gangrene. The reasons for his delay are cultural stigma associated with sexual practices and health illiteracy.

Foreign bodies in the sigmoid colon of a psychiatric patient following self-mutilation: a case report

BACKGROUND

The act of deliberate injury to one's own body without the help of others is a well-known phenomenon in psychiatric patients. Insertion of foreign bodies into one or more orifices is not uncommon but insertion into a body cavity or the gastrointestinal tract by self-inflicted injury is quite rare.

CASE PRESENTATION

A 32-year-old Ethiopian psychiatric patient presented with left lower abdominal pain of three months' duration following the insertion of foreign bodies via a self-inflicted wound in the left lower quadrant of his abdomen. Radiological evaluation demonstrated the presence of foreign bodies. A laparotomy revealed two metallic and three wooden materials in his sigmoid colon and a hole in his sigmoid that was tightly sealed with omentum. The foreign bodies were successfully removed, the hole was closed primarily, and our patient was discharged uneventfully.

CONCLUSIONS

This case illustrates that a foreign body can be inserted into the colon through a self-inflicted wound in psychiatric patients, and patients may present months later without having developed generalized peritonitis.

Retrospective Audit of the Management of Anal Insertion of Foreign Bodies: A Holistic Approach

Most patients with voluntary anal insertion of a foreign body (IFB) present to the emergency department and are then managed by the surgical team. This report reviews the medical literature on IFB and includes results of a chart review of operative logged interventions and clinically coded procedures for anal IFBs at a single acute hospital in the United Kingdom between May 2009 and September 2013. The objective was to establish the current practice in the management of anal IFB and update a framework for the initial workup, surgical procedure, and appropriate mental health intervention.

An unusual case of polyembolokoilamania: Urethral avulsion from foreign object use during sexual gratification

Polyembolokoilamania is the insertion of foreign objects into body orifices for sexual gratification. While the retrieval of these objects from the urethra and bladder is a well-known task among urologists, we present a rare case of an usual and serious injury from this practice: complete avulsion of the urethra at the penoscrotal junction. A single-stage urethroplasty was used to reconstruct the urethra with good result. The patient motivation, as well as concomitant medical or psychological conditions, should be explored in order to prevent further occurences.

Foreign bodies in the abdomen: self-harm and personality disorders

A 52-year-old woman presented to the accident and emergency department 5 h after deliberately stabbing herself with two pens through her midline laparotomy scar. Her medical history included an emotionally unstable (borderline) personality disorder and she was currently an inpatient in a psychiatric hospital. She had multiple accident and emergency attendances with previous episodes of self-harm. Clinical examination revealed evidence of trauma to her midline laparotomy scar with congealed blood covering the puncture site. Her abdomen was soft and non-tender on palpation. A chest radiograph revealed no air beneath her diaphragm and her abdominal radiograph identified a radiopacity in her upper right abdomen and dilated loops of small bowel. CT of the abdomen and pelvis confirmed two pens, with the lower pen tip reaching the pancreas. A midline laparotomy was performed and both foreign bodies were extricated unremarkably. The patient's postoperative recovery was uneventful. The second case involves a 22-year-old woman, a psychiatric hospital resident, presenting to the accident and emergency department 5 h after deliberately inserting the metal nib and inner plastic ink containing tube of a pen through her umbilicus. Her medical history included an emotionally unstable (borderline) personality disorder and paranoid schizophrenia. She had multiple accident and emergency department attendances with previous episodes of self-harm. Clinical examination revealed a soft, non-tender abdomen. Her chest radiograph was unremarkable and her abdominal radiograph identified a radiopaque foreign body at the right upper quadrant of the abdomen. CT of the abdomen and pelvis confirmed a metallic foreign body in the small bowel mesentery. An exploratory laparotomy converted to a midline laparotomy was performed and the foreign body was extricated. The patient's postoperative recovery was uneventful.

Multiple impacted urethral metallic needles and screws (foreign bodies) associated with polyembolokoilamania

This study aims to present the challenges faced in the management of multiple impacted foreign bodies, needles, and screws from the penile and bulbar urethra. A young man presented with complaint of a hard perineal swelling and passage of metallic nails per urethra. Pelvic radiograph revealed multiple foreign bodies (nails) in the penile and bulbar urethra. Successful cystoscopic removal of 11 foreign bodies comprising four large metallic screws and seven nail-like large sewing needles was done in two sessions. The most prevalent motivation for self-insertion of urethral foreign bodies is autoerotism/psychological impairment. Appropriate surgical technique guided by physical examination/ imaging with endoscopic removal is often successful, depending on the object's physical attributes and morphology while minimizing urothelial trauma and preserving voiding and erectile function. Follow-up cystourethroscopy is important for diagnosing any complications and urothelial injuries.

An unusual urethral foreign body

INTRODUCTION

Lower urinary tract foreign body insertions have a low incidence. The motives for insertion of a variety of objects are difficult to comprehend. This case warrants discussion given the great management challenge faced by the oddity and infrequency with which a fork is encountered in the penile urethra.

PRESENTATION OF CASE

A 70-year-old man presents to the Emergency Department with a bleeding urethral meatus following self-insertion of a fork into the urethra to achieve sexual gratification. Multiple retrieval methods were contemplated with success achieved via forceps traction and copious lubrication.

DISCUSSION

The presentation of urethral foreign bodies can vary widely, as can the type of object inserted. The most prevalent motivation for self-insertion of urethral foreign bodies is autoerotism. Motivations ought to be explored in light of possible underlying psychological or psychiatric conditions. The most appropriate surgical extraction technique can be guided by physical examination and imaging. Endoscopic removal is often successful, depending on the object's physical attributes and morphology. It is important to arrange appropriate follow-up, as late complications can occur such as urethral strictures.

CONCLUSION

Psychological and surgical arms encompass the management plan. Foreign body retrieval is determined by its physical attributes and morphology with the aim to minimise urothelial trauma and preserve erectile function. Essentially, endourological extraction serves the primary means of retrieval. Cystourethoscopy is important to diagnose urothelial injuries and to ensure complete removal of foreign bodies following extraction.

Polyembolokoilamania: Self-insertion of transistor radio antenna in male urethra

Though self-insertion of a foreign body in the male urethra is an infrequent urologic emergency, a weird variety of self-inserted foreign bodies have been reported. Most of these are attributed to autoerotic stimulation, a consequence of mental illness or the result of drug intoxication. We report an unusual case of a 65-year-old African man who self-inserted a broken transistor radio antenna into his urethra to serve as an improvised ‘itchstick’ to ease a bothersome itchy urethral condition. The foreign body subsequently migrated proximally out of reach. He presented a week after with urethral bleeding following nocturnal penile erections and we describe his evaluation and the challenge of retrieval. The reasons for self-inserting objects into the urethra may be as varied as the foreign bodies themselves and may include objects being used as an improvised ‘itchstick’ for itchy urethral conditions. The urologist's creative tendencies will often be required in safely removing these objects.