Intentional impaction of rectum by mattress sponge pieces (foreign bodies) leading to intestinal obstruction in a mentally ill patient: Case report and literature review

AbstractBackgroundIt is more difficult for the treating team to make the right diagnosis at the right time in mentally ill patients due to poor history and sometimes a masked clinical presentation. The presence of an unprofessional guardian may increase the challenges, as in our case, due to hidden or even misleading history, especially with an older age group. Intentionally inserted sponge material in the rectum to reduce the frequency of loose stool evacuations in patients with diarrhoea is a new phenomenon not discussed in medical literature.Case summaryWe report a case of an 85-year-old bedridden female with a history of stroke, hemiplegia, and dysarthria. She presented to our emergency department with significant abdominal distention and vomiting. She was attended by an unprofessional guardian (hired by her family). The history provided by the guardian was of abdominal distention and constipation 5 days prior to presentation, followed by vomiting feculent material. A physical examination revealed she had a distended tympanic abdomen without organomegaly, scars, or hernia. A digital rectal exam revealed a few pieces of a foreign body similar to sponge material with a fully distended rectum with well-formed stool. The guardian admitted that this was a sponge material used by her to reduce the frequency of stool evacuation. Removal of the foreign body by the medical team led to complete recovery in the same day.ConclusionThe treating team may face more challenges in treating patients with an inability to provide a proper history, especially if accompanied by an unprofessional guardian