Intraperitoneal foreign body following repeated self-mutilation: a case report

Background: A foreign body found incidentally on abdominal X-ray is commonly secondary to ingestion, either intentional or accidental. It can also lodge within the peritoneal cavity following a definite history of an incident of penetrating injury to the abdomen by a sharp penetrating object. It is a rare instance where a blunt object penetrates the abdominal wall following chronic, repeated self-inflicted trauma to the umbilicus. Case Description: We report a case of a young man with a history of repeated habitual self-mutilation to his umbilicus using a blunt object, with no intention of self-harm. This led to the lodgment of the object within the peritoneal cavity. An initial diagnostic challenge arose due to the absence of abdominal symptom as well as physical sign of injury on the abdomen. Computed tomography (CT) scan was unable to distinguish between intra- vs. extra-luminal location of the object, due to the presence of significant artifacts. The exact location of the object was successfully determined by laparoscopic examination. The patient was treated by laparoscopic extraction of the foreign body. He was discharged well following surgery. Conclusions: Laparoscopic surgery is invaluable in the diagnosis and management of intraperitoneal foreign object whose location cannot be ascertained by CT scan.