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

## TL;DR

A man with intellectual disability inserted a bidet shower rectally, requiring careful medical and psychiatric care due to the complexity of such cases.

## Contribution

The paper presents a case emphasizing systematic protocols for rectal foreign body removal and the need for psychiatric follow-up in patients with intellectual disability.

## Key findings

- A 23-year-old male with intellectual disability had a bidet shower removed rectally under general anesthesia.
- Postoperative imaging confirmed no complications from the foreign body or the procedure.
- The patient was referred for psychiatric evaluation but was lost to follow-up.

## Abstract

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.