Suicide attempt by self-stabbing of the bladder: a case report

Abstract

IntroductionThe presence of foreign bodies in the bladder often falls within questionable practices in psychiatric settings or in iatrogenic instances such as during endoscopy or migration of foreign bodies around the bladder remaining after surgery on organs close to the bladder. Psychiatric disorders have been reported in patients admitted for self-introduction of foreign bodies in the bladder during an act of sexual satisfaction. However, to the best of our knowledge, no similar case in the context of suicide has been reported in the English-language literature.Case presentationA 56-year-old Moroccan man known to have untreated paranoid schizophrenia and a history of several previous suicide attempts was presented to the emergency unit of our hospital after self-stabbing with a 15cm sewing needle. His stab wound was located at the hypogastric region of the abdomen, with full penetration of the needle into the abdomen. A computed tomographic scan showed a breach on the dome of the bladder responsible for extravasation of the contrast dye, which revealed a peritoneal cavity effusion of average abundance and a suspected lesion of the left pelvic ureter. An exploratory laparotomy was performed. Approximately 1000mL of widely dispersed fluid was observed in the abdominal cavity. During exploration of the bladder, two centimetric intrabladder breaches were found, one of which was a breach of the left pelvic ureter without other associated lesions. The breaches were sutured, and a ureteral catheter was mounted. The patient’s post-operative follow-up was unremarkable.ConclusionsThe wide variety of ways that foreign bodies are introduced into the lower urinary tract pose diagnostic and therapeutic difficulties for the urologist. Management of these patients is facilitated by the use of endoscopy.

Acute Generalized Peritonitis Due to the Migration of a Ballpoint Pen from Bladder to Great Peritoneal Cavity: A Case Report

“…The presence of a foreign body in the urinary tract systematically raises the question of the circumstances of its introduction [1]- [7]. Among these circumstances, some often seem to be anecdotic.…”

“…The presence of an object into the bladder for masturbation purpose or other forms of sexual variation is the mains circumstances of self-insertion of a bladder foreign body through the urethra [1]- [9]. However, many cases are associated with dementia, other psychiatric abnormalities, or drug intoxication [7]- [9]. Cases of Intravesical migration of intrauterine device had been described in the literature [1].…”

Foreign bodies in the abdomen: self-harm and personality disorders

“…Published psychiatric literature on this is meagre.”15 Indeed, he reported an unusual case of self-mutilation involving the introduction of 40–50 needles of various types (injection needles, sewing needles, paper pins) by a 53-year-old single man suffering from paranoid schizophrenia 2. Several case reports have described recurrent ingestion of foreign bodies and abdominal self-injury with multiple paperclips and needles embedded in the abdominal wall, as a form of attempted suicide 16 17. In addition, Vela et al 18 described the case of a 32-year-old man with associated psychopathology who had 35 operations for self-inflicted wounds.…”