HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Linnau, K. F. Articles by Mann, F. A. Search for Related Content PubMed PubMed Citation Articles by Linnau, K. F. Articles by Mann, F. A. Social Bookmarking                      What's this?

Doll's Head "Bezoar": Complete Craniocervical Dislocation Causing Bowel Obstruction

¹ Both authors: Department of Radiology, Harborview Medical Center, Box 359 728, 325 Ninth Ave., Seattle, WA 98104-2499.

Received August 14, 2002; accepted after revision September 16, 2002.

 
Address correspondence to F. A. Mann.

This is another in the continuing series on radiology in trauma cases from the Harborview Medical Center. Editors: Fred A. Mann, Eric J. Stern, and Lee B. Talner.

A35-year-old man presented with severe abdominal pain and distention but normal vital signs. An abdominal radiograph (Fig. 1A) showed multiple rounded objects, some of which projected in the shape of a head with a pointed nose (Fig. 1B). Suspecting a case of "body packing" [1], we questioned the patient as to whether he had ingested packets filled with illicit drugs for the purpose of smuggling. However, the patient stated that he had ingested multiple heads of a popular children's toy doll over the course of several days. He declared that swallowing dolls' heads was his habit for anal autoerotic gratification. The patient's hospital course was uneventful after surgery for mechanical small-bowel obstruction.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —35-year-old man who presented with clinical signs of bowel obstruction. Abdominal radiograph shows multiple round head-shaped objects (arrowheads).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —35-year-old man who presented with clinical signs of bowel obstruction. Detail of abdominal radiograph shows objects having doll-like noses (arrow) and doll-head occiputs (arrowheads).

Certain dolls (Fig. 2) are icons of American popular culture. For example, an Internet search with the keyword "Barbie doll" renders more than 200,000 hits, and Barbie remains an integral part of many toy collections of millions of children all over the globe. The doll was the subject of a United States Postal Service stamp in 1999, and she has been the topic of editorials [2] and has caused debates about the portrayal of women's body image [3].

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Lateral radiograph of doll shows craniocervical junction (arrowheads). Nose, head, and hair of doll are radiodense.

In this case of small-bowel obstruction resulting from craniocervical dissociation of a doll, common search patterns used to detect atlantooccipital distraction injury [4] do not apply. Radiographically, dolls' heads (Fig. 2) do not show a clear basion–dens interval or posterior axial line [4]. A denslike structure that has a cylindric convexity connects the doll's cranium to the doll's body in a hinge joint (Fig. 2). The entire head of the doll, including nose and hair, are radiodense (Fig. 2). Familiarity with the radiographic appearance of this famous American doll may help to differentiate the foreign bodies in the bowel of our patient (Fig. 1A, 1B) from packages of illicit drugs ingested by body packers [1].

Motives for ingestion of foreign bodies vary greatly [5]. To our knowledge, ingestion of dolls' heads for anal autoerotic gratification has not been described previously. Most ingested foreign bodies pass the small and large bowels without serious consequence [5], and patients seek medical help only if the passage is impeded at anatomic narrowings [6]. Body packers smuggle illicit drugs (such as cocaine or heroin) in multiple ingested packages [1] and may present as a toxicologic emergency with life-threatening symptoms caused by a leaking substance from a broken package [6]. Rectal foreign bodies rarely come from ingestion but more commonly are the result of conscious insertion [6].

Radiographic detection of the characteristic nose and the unique features of the craniocervical junction of famous dolls (Figs. 1B and 2) may serve as a clue to identify the doll radiographically, even if located in the bowel of an individual. This case illustrates how icons of popular culture affect all aspects of life and can present emergently to the radiologist, who should keep in mind that human imagination may not follow clinical algorithms.

Acknowledgments
 
We thank George Pleitz for bringing this case to our attention and Julie M. Thompson and Clara L. Cone for their assistance in the radiologic evaluation of the doll.

References

Top References

 

1. McCarron MM, Wood JD. The cocaine “body packer” syndrome: diagnosis and treatment. JAMA 1983;250:1417 –1420[Abstract]
2. Goodbye to Barbie's maker. New York Times, April 30, 2002: A28
3. Kershaw S. Ruth Handler, whose Barbie gave dolls curves, dies at 85. New York Times, April 29, 2002: A1
4. Deliganis AV, Baxter AB, Hanson JA, et al. Radiologic spectrum of craniocervical distraction injuries. RadioGraphics 2000;20[suppl]:S237 –S250[Abstract/Free Full Text]
5. Blaho KE, Merigian KS, Winbery SL, Park LJ, Cockrell M. Foreign body ingestions in the emergency department: case reports and review of treatment. J Emerg Med 1998;16:21 –26[Medline]
6. Stack LB, Munter DW. Foreign bodies in the gastrointestinal tract. Emerg Med Clin North Am 1996;14:493 –521[Medline]

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Linnau, K. F. Articles by Mann, F. A. Search for Related Content PubMed PubMed Citation Articles by Linnau, K. F. Articles by Mann, F. A. Social Bookmarking                      What's this?