AJR 2003; 180:986
© American Roentgen Ray Society
Trauma Cases from Harborview Medical Center |
Doll's Head "Bezoar": Complete Craniocervical Dislocation Causing Bowel Obstruction
Ken F. Linnau1 and
F. A. Mann
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.
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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).
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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].
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
- McCarron MM, Wood JD. The cocaine “body
packer” syndrome: diagnosis and treatment.
JAMA
1983;250:1417
–1420[Abstract/Free Full Text]
- Goodbye to Barbie's maker. New York Times,
April 30, 2002: A28
- Kershaw S. Ruth Handler, whose Barbie gave dolls curves, dies at
85. New York Times, April 29,
2002: A1
- Deliganis AV, Baxter AB, Hanson JA, et al. Radiologic spectrum of
craniocervical distraction injuries. RadioGraphics
2000;20[suppl]:S237
–S250[Abstract/Free Full Text]
- 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]
- Stack LB, Munter DW. Foreign bodies in the gastrointestinal tract.
Emerg Med Clin North Am
1996;14:493
–521[Medline]
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