A Case of Shock Associated with Mesenteric Injury and Severe Intraabdominal Hemorrhage Resulting from an Unusual Sexual Practice

Abstract

A 57–year–old man with a history of atrial fibrillation under treatment with warfarin, had a habit of inserting a tubular rod about 30 cm long into his anus during masturbation; he called the emergency medical service after 2 days of progressively worsening lower abdominal pain that began a day after he masturbated using the rod, and was transported to our hospital. On arrival, he was in a shock state, with a systolic pressure of 40 mmHg measured by palpation. His hemodynamic status improved with rapid fluid infusion. Abdominal CT revealed a large amount of abdominal fluid within and adjacent to the mesentery near the rectal Rs portion, but there was no evidence of intraperitoneal free air. From the history, we diagnosed the patient as having developed rectal and mesenteric injury and intraabdominal hemorrhage caused by the tubular rod that he had inserted into his anus. We performed segmental resection of the rectum and colostomy, and succeeded in saving the patient. Transanal insertion of foreign bodies can cause hemorrhagic shock with intraabdominal hemorrhage, and timely diagnosis and treatment with proper history taking is essential.