Answer: This is not a case of sexual abuse: the foreign body was an attempt at self-stimulation.
The teen was taken to the operating room and a toothpaste dispenser was recovered from his rectum. After interviewing the parents, the mother’s boyfriend, and the teen, there were no red flags in their interviews. The story as relayed by the mother and boyfriend fit the timeline in the teen’s disclosure. The teen’s final statement was that this had been an attempt at self-stimulation. The case was closed as non-abuse. The teen was discharged to his mother’s home for convalescence.
A review article surveyed the world literature of anorectal trauma and autoeroticism.1 One of the primary complications in a scenario like the one described in this case is perforation or pressure necrosis causing sigmoid perforation and its many ramifications. Anal stimulation is performed for sexual gratification in 60% to 78% of cases; however, up to 40% of those cases were related to sexual assault.1 Of the cases reviewed, 99.1% were in males aged 16 to 80 years. In one study reviewed, only a third of the men who presented for medical care stated that they had inserted an anal foreign body. The other two-thirds of patients had only vague complaints of rectal or abdominal pain.
As with most cases of abuse or mimics, a high index of suspension is necessary to make the diagnosis.
1. Yacobi Y, Tsivian A, Sidi AA. Emergent and surgical interventions for injuries associated with eroticism: a review. J Trauma. 2007;62:1522-1530.