Sexual Abuse—or Mimic?

A 13-year-old boy and his father presented to an emergency department (ED) stating that something was lodged in the teen’s rectum. The father, who was the boy’s primary care giver, stated that the teen had spent the weekend with his mother and her boyfriend. After the teen arrived at his father’s home, he divulged that he had had something in his rectum for 3 hours or more. The father immediately alluded to concerns of abuse by the mother’s boyfriend.

The teen stated in his father’s presence that he had been showering and then slipped on something and fell. He reported that something had gone into his rectum when he fell. He thought it was a toothpaste dispenser. His story changed a few seconds later. This time he said that when he got out of the shower he inadvertently sat on a toothpaste dispenser that was on the toilet seat. The teen gave yet another account to the radiologist when x-rays films (Figure-click to enlarge) were being obtained and when his father was not present. That version of the story was equally unbelievable.

Multiple attempts to remove the object failed in the ED. Surgery was consulted.

As the hospital social workers began their investigation, the father recalled that his son had stated multiple times over the years that he did not want to go to his mother’s home. Child Protective Services was notified. 

Has this teen been abused, or is there another possible explanation?

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