An imperfect end

Frankly, this is a bit gross. I’ll put the post below the fold, and read at your own risk. You’ve been warned.

Removal of a rectal foreign body is simple, really: Locate it, grasp it firmly, break the ‘suction’, and pull. Seems simple, and like most seemingly simple tasks it’s harder to accomplish in real life.

The patient of a colleague had just such a complaint, and I willingly agreed to help remove the object, which we had an x-ray of, a common vibrator. On delegation of tasks my colleague would be in charge of the patients’ sedation, and I was on removal duty.

I had all I needed, a plastic and lit vaginal speculum, ring forceps, some nice plastic tubing (for suction relief), and lube.

The patient was suitably sedated, and it was time to proceed. The speculum was inserted, and no foreign body was visible until the anterior abdomen was compressed, and !viola!, it appeared. I saw a small area of man made black color, and the unmistakable edge of a condom on its edge. I carefully grabbed the rim of the condom (at the near-limit of the reach of the ring forceps, probably 8 inches in) and began to hopefully tug.

Hope may well float but condoms just break, and when they do they recoil in both directions with fervor and throw-off anything attached. In this case I protected the team by taking the hit squarely in the face. (This has become something of a topic of conversation in my ED).

No, I wasn’t wearing protection beyond beyond my usual spectacles. I did try another two times to grasp the end of the vibrator with the ring forceps, but could never get enough of a hold to even attempt to break the suction (due to the tapered design of the end of the vibrator) (which design I learned from reading the Internet).

In retrospect, a tenaculum might have allowed a better grip on the vibrator, but given our thorough attempts the surgeon on call took the patient in and the object out.

I washed my face at the sink for a nice, long time, and have thought about getting a tenaculum prior to the next time. Oh, and one of those face mask-shield things.


Comments

  1. I thought the taper would be on the proximal aspect of the FB. Odd… Tandem design???

    I had a very similar patient but she was British. I got a kick out of how dignified she sounded despite the circumstances.

    They should be manufactured with some type of cord for retrieval of runaways. The tampon industry is light-years ahead… Or some type of T-design that stops runaways at the door.

    I am sitting here at work (it is a slow shift) laughing out loud. I have a weird sense of pride in (perhaps) coining the term “runaways” for irretrievable vibrators. I hope everyone that reads this will make an effort to help it catch on.

  2. When I was working the FB that I did in the ER, the attending physician instructed the poor couple experiencing this that in the future, they should insert nothing that had a flange smaller than a human body on the end to ensure that there was no “loss”.

  3. Eeeeew! Brain bleach! Brain bleach!

    (I haven’t had to do this. Yet.)

  4. “flange smaller than a human body…” love it, made my day!

  5. Hmmmmm.

  6. RiahRiddle says:

    GROSS! Thanks for making me never want to be a doc…

  7. Goatwhacker says:

    Gruntdoc if you routinely agree to help colleagues remove rectal foreign bodies, you are truly a man among men. Or possibly very odd. Or both.

  8. TheNewGuy says:

    I had one of these a few years ago, and it came with a story, as many of them do.

    Married guy out drinking at a bar with his wife, and had an opportunity to get it on with two, hot twenty-something lesbians (confirmed by the wife, who had no problem with it… apparently an “open” marriage). He engaged in a menage a trois with these young ladies, reportedly with great gusto. He ended up in the ER with a vibrator (still running) in his rectum, terribly embarrassed at the entire situation.

    I couldn’t help grinning as he told me the story, since there are plenty of guys who’d have stepped up the plate given an offer like that. I told him as much, advised him not to sweat it, that we were happy to help him out.

    I later related the story to a colleague (including the part about the hot lesbians). After I finished, my colleague thought for a second, looked me in the eye, and said “totally worth it.”

    Heh… the things you learn.

  9. Back in the day, when I talked about sex for a living, one of the most frequent educational points I had to make was this: Salad ingredients and sports equipment should not be used for other than their intended purposes.

    The second-most-frequent educational message was that there are things out there meant specifically for rectal insertion (ie, “butt play”), and they do indeed have flanges. Going crazy with anything else is asking for trouble.

  10. Canadian ER Doc says:

    “Heh… the things you learn.”

    Had an embarrased looking lady in our ER two years ago off an overnight trans Atlantic flight.

    The object ? – airline mini-spirits bottle, inserted bottlecap end first.

    Removed it between my index and middle fingers, much to our surgeons delight (and amusement).

    Didn’t require sedation either : must have been a frequent flyer ;-)

  11. The other daughter... says:

    I think this may top the time that I was with you when you were reducing a basketball sized abd hernia and the guy threw up on you…just maybe. You should borrow T Mac’s panther vision glasses and work on those cat-like reflexes. Wish I could have been there…med school always ruins my fun.

  12. Goatwhacker: both.

  13. i wonder if your teeth chatter when it gets lost? will have to ask the next ‘victim’.

  14. I am in awe of the incredible level of professionalism it would have to take to perform that little procedure.

    As an old psychiatrist friend used to tell, me: “There is nothing I find strange about human behavior.”

    Your concern for the patient is beyond admirable.

  15. Nurse 1961 says:

    Assisted in the removal of 5/8 box end wrench, story was he fell and sat on it.

    No we didn’t believe him either.

    Ended up with exploratory lap and perforated colon.

    “Mr. Goodwrench” was discharged and told to be careful when at work next time.

  16. ChaosManagement says:

    Had a similar circumstance a few years ago. Medics transported a fellow who had a toilet plunger well-lodged in his hind end, handle first, suction cup protruding. They had no protocol for transporting someone with this malady, so they put him on the stretcher like the “Sphinx” with a sheet thrown over his backside. Made for some very curious glances from staff and patients.

  17. it´s in him and it got to come out — John Lee Hooker

  18. beachdoc says:

    I have never seen a patient with a lost vibrator that presented until AFTER the batteries were dead……….

    Vaginal packing forceps are an effective removal tool!

  19. Hmmm….the only thing I distinctly remember seeing on x-ray was a bottle of Arrid Extra Dry way high up where only surgeons tread. How did I know it was Arrid? Distinctive shape of the container. Called it immediately! : D

    Maybe if they offered vibrating deodorant containers they could take care of two things with one application! : D

  20. We had a case a few years ago with an elderly gentleman with a butternut squash. He ended up having to go to surgery where they took it out piece by piece.

  21. Was the patient in some sort of serious pain? Was there some sort of impaction of feces, immovable obstruction, or other circumstance that posed some dangers? If not, I’m wondering if perhaps giving her/him instructions to try eating three or four bananas with a few bowls of all bran or oatmeal might be worth a try. From your description of the rambling device, there was no real impediment to it making a normal exit on its’ own, particularly if you could apply some lubrication and perhaps even turn the device on.

  22. Did you know the lable on a “Brute” bottle is radio opaque?

  23. I remember this night! I tell the story at least twice a week how I found [GruntDoc] scrubbing his face in the Trauma med room! Somehow it always comes up! No idea why! Could it have something to do with how I have a picture of that Xray in my trusty iPhone? You didn’t hear that from me! :)

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