28 July 2021

Live eel, traffic cone … the things you find in patients

Clinical longread Surgery

Here’s to the doctors wrangling aquatic wildlife and anuses that could blow up an operating theatre.


There comes a time in a medical journalist’s life when she has read so many case studies of strange things removed from people that the urge to collect them all in one place becomes overpowering.

Reader, this is that time.

Begin at the bottom

After seeing myriad reports of hapless patients losing their footing in the bathroom or kitchen and finding inanimate objects pulled into the path of their descending rectum, it has become clear that some anuses possess an immense gravitational pull.

Items that have fallen prey to this phenomenon include a balloon whisk, case of reading glasses, umbrella, lightbulbs and branch from an apple tree.

Although hospital presentations for impacted rectal foreign bodies are reportedly increasing, the urethra and vagina appear viable alternatives for those wishing to flirt with the risk of infection or incontinence while forgoing a side-order of perforated bowel.

But spare a thought for the unsuspecting doctor, who faces not only the challenge of diagnosing a traffic cone in the lung, but also wrangling aquatic wildlife and potentially exploding rectums.

TMR is not yucking anyone’s yum, but for objects intentionally introduced to the anus, please plan ahead. And please, for the love of Jacques Cousteau, never involve live eels. 

There once was a 50-year-old patient, reported in Surgery, who presented to the emergency department of Kwong Wah Hospital in Hong Kong in 2003 after inserting a 50cm live eel into his rectum in a bid to relieve constipation.

The eel (a creature that hunts by smell) appeared unimpressed at being considered a knock-off Coloxyl and bit the patient’s colon. An emergency laparotomy revealed a three-centimetre perforation over the anterior wall of the rectum, necessitating a colostomy.

The patient was discharged after an uneventful recovery. No further information was provided as to the eel’s status, but one hopes it t was not the same creature found inside the rectum of a patient presenting to New Zealand’s Auckland City Hospital in 2012.

A notable mention also goes to the surgeons in India who removed an aerosolised can of Axe deodorant from a 21-year-old man’s rectum, noting the “real concern of fire and explosion during surgery”.

A real firecracker

In other explosive news, health workers attending a 44-year-old male patient at a US emergency department had to call the bomb squad for advice when it was revealed an undetonated firework was lodged in his right leg.

The patient had been reloading the tube of a mortar firework device after a presumed dud, when it launched the shell into him instead of the air.

The treating team noted his leg was “grossly unstable” (see Fig.1 if intrigued) and an X-ray revealed a comminuted distal femur fractur with multiple impaled radiopaque foreign bodies.

They put the man in isolation, told him not to move, and contacted the Explosive Ordnance Disposal unit who dispelled fears the firework would self-detonate but recommended bringing in the fire department to help with removal – which included thorough irrigation with water, avoiding electrocautery and bagging the wet firework to avoid delayed detonation.

Party time

Rainbow rig

Things were not running smoothly for a 62-year-old man hospitalised with a suspected penile tumour, until he revealed a decade-long history of injecting motor oil into his penile shaft for genital augmentation purposes.

The oily addition induced a foreign body reaction – sclerosing granuloma of the penis – along with microscopic patches of iridescence.

“For the first time, we report the dermoscopic description of sclerosing granuloma … [and] the first description of a dermoscopic rainbow pattern in a granulomatous disorder,” the treating dermatologists wrote.

Unusual urethra

The world-weary authors of another case report noted various types of foreign bodies have been recovered from the urinary bladder and urethra, including “telephone cables, pocket battery, little fish, pen tips and so on.”

In just another day at the office, they recounted the case of an 18-year-old boy with a normal psychiatric evaluation who had inserted an electric wire into his urethra for autoerotic purposes.

The wire was now in the patient’s bladder but so tangled the doctors had to first use a holmium laser to cut it up, insert a sheath into the bladder neck to reduce injury, then remove the wire pieces endoscopically.

Out of the box

Another tale of attempted sexual gratification gone awry includes the woman who inserted a plastic box filled with debris into her vagina.

The 26-year-old reported the box had become stuck, leading to pain and fainting during sexual intercourse and foul-smelling vaginal discharge. Examination revealed vesicovaginal fistula, which was repaired three months after the box was removed – and the doctors reported that the patient conceived 1.5 years later.

For another woman, the common tampon was the culprit of persistent pain – though the location was extraordinary, with the sanitary item being lodged in her intestine.

The 49-year-old had undergone a hysterectomy three months prior and said she used tampons for postoperative blood loss.

But following “vigorous sexual intercourse” one was now inside her abdominal cavity.

Minilaparotomy revealed total rupture of the vaginal vault, and that the patient’s self-assessment was correct.

The doctors published the first CT imaging of a tampon in the abdominal cavity, saying the case served to “highlight the relevance of patient self-report”.

Iron overload

In 2016 a 42-year-old policeman in northern India hit international headlines when he presented to hospital suffering from excess iron – in the stomach.

The patient admitted to swallowing a knife per day for around two months, leading to a five-hour surgery in which 40 folded and unfolded blades, some of which measured up to 18cm, were removed.

“He had a wild urge to consume metal. Even for us, the experienced surgeons, it was frightening,” lead surgeon Dr Jatinder Malhotra told CNN.

But similar reports were to follow: in May 2019 another team of surgeons in northern India removed an assortment of metallic objects, including eight spoons, a kitchen knife and two toothbrushes from a 35-year-old man’s stomach.

And a month later a younger man had an incredible 80 objects extracted from his gut, including a necklace, a type of clay pipe used for smoking marijuana, nail cutters, glass and keys.

Traffic jam

A 50-year-old British postal worker made headlines in 2017, in a case his doctors said was the longest period that a foreign object had been unknowingly lodged in someone’s airway.

Paul Baxter had unwittingly been harbouring a small plastic traffic cone in his lung for over 40 years.

But it was only in the past year that he felt unwell and began coughing up phlegm. An X-ray revealed a mysterious mass in his lung, which during a bronchoscopy was revealed to be a toy traffic cone “masquerading as bronchial carcinoma”.

Baxter told the doctors he remembered getting a Playmobil set for his seventh birthday.

The authors said tracheobronchial foreign body aspiration diagnosis may be delayed for more than a week in a small proportion of children but a four-decade delay in symptom onset was “unheard of”.

“This may be because aspiration occurred at such a young age that the patient’s airway was able to remodel and adapt to the presence of this foreign body,” they suggested.

‘Straya, mate

A common misconception overseas is that all wildlife in Australia wants to kill you – but maybe the critters just want a little nap inside you?

In 2014, a man in Darwin was woken at 2:30am by a sharp pain in his ear that escalated when he tried to first suck the mystery guest out with a vacuum cleaner then drown it with water, apparently angering it and causing agonising pain.

Hendrik Helmer told ABC Local he hoped it wasn’t a venomous spider – a wish that was at least granted, when a Royal Darwin Hospital doctor used olive oil and forceps to reveal a 2cm cockroach.

Fishing for attention

 ‘A jackass and a fish: A case of life-threatening intentional ingestion of a live pet catfish’ details the saga of a group of young Dutch men who, after imbibing considerable amounts of alcohol and ecstasy, attempted to imitate the stunt TV series Jackass and began topping their beers with goldfish from a home aquarium.

One among the cohort (there’s always one), then selected a bronze catfish from the tank as the pièce de resistance.

The fish activated its “anti-predator behaviour”, erecting and locking the spines of its pectoral fins and – despite the patient’s best efforts to wash it down with ice-cream and more beer – remained firmly lodged in his hypopharynx.

It’s worth reading the report by the treating team – who successfully removed the then-dead fish and one of its firmly lodged fins in two separate procedures – even if only for the description of the two-minute home video the patient helpfully played for them on presentation to the hospital.

The end

Now that I have this story out of my system, if you see more examples of weird things removed from people, please don’t hesitate to keep them to yourself.