Spring onion as a foreign body in the urethra.

We report a case in which a spring onion was inserted into a patient's urethra and bladder by his wife. Because vegetables are radiolucent, we used abdominal computed tomography to make the diagnosis. A spring onion was pulled out completely, and no residual plant material remained inside the bladder.

Introduction

With respect to the insertion of foreign bodies into the urethra, a wide variety of objects has been reported. Reports have documented the insertion of needles, pencils, batteries, ballpoint pens, wires, and pins, and a plain X-ray exam of the pelvis has easily confirmed the presence of these objects.1, 2, 3, 4, 5 Herein, we report a case in which a spring onion was inserted into a patient's urethra and bladder by his wife. Because vegetables are radiolucent, we used abdominal computed tomography to make the diagnosis.

Case presentation

An 89-year-old older man visited the emergency department with complaints of urinary frequency following the insertion of a long spring onion into his urethra by his wife the previous day. There was no prior history of insertion of any object into the urethra. Because the patient experienced an itching sensation over the meatus the day before, his wife used some olive oil and inserted a fresh spring onion into his urethra. The spring onion broke while the patient's wife tried to pull it out of the urethra.

Locating the spring onion through a simple physical examination was difficult. The plain X-ray of the pelvis did not indicate the presence of a foreign body inside either. Abdominal computed tomography revealed a tubular foreign body in the middle part of the urethra, starting 8 cm from the opening of the urethra and extending continuously to the bladder (Fig. 1).

Fig. 1

Abdominal computed tomography revealed a spring onion (arrow) 8 cm from the opening of the urethra and extending continuously to the bladder.

Suspecting the presence of a foreign body in the urethra, a 22Fr cystoscope was used to conduct cystoscopy under local anaesthesia. The tip of the spring onion was located in the bulbar urethra (Fig. 2a) and was removed using biopsy forceps. A 30-cm long and 0.6-cm wide spring onion was pulled out completely, and no residual plant material remained inside the bladder (Fig. 2b).

Fig. 2

Spring onion identified as the foreign body in the urethra. (a) The spring onion under cystoscopy. (b) Spring onion measuring 30 cm in length.

We advised the patient to undergo a psychiatric evaluation, but he refused. He visited the outpatient department for a follow-up visit 1 week after the intervention. He appeared well and did not complain of any discomfort.

Discussion

Spring onions are vegetables, which have hollow tubular green leaves that grow directly from the bulb.

In this type of case—the insertion of a foreign body into the urethra—treatment is often delayed because of patient embarrassment. In this particular case, the spring onion was inserted from the urethra to the bladder and acted like a urethral stent, which caused the symptom of frequency that greatly bothered the patient.

It is crucial to learn the complete history of a patient and to use the appropriate radiological tool to confirm the size, consistency, and location of a foreign body. Typically, in the common cases of metal foreign body insertion, an X-ray exam can be used to successfully identify an object. However, here, computed tomography was used to identify the object because of the radiolucency of the vegetable material.

When possible, the less invasive procedure should be performed to minimise the risk of bladder and urethral injury.

Psychiatric consultation is necessary to prevent recurrence and also to determine whether a patient has suicidal tendencies.

Below are four important tips (HELP) for treating a case of foreign body insertion into the urethra:

Patient history should be traced completely

The appropriate radiological tool should be used for evaluation

The less invasive procedure should be selected to remove the foreign body

Psychiatric evaluation should be made to avoid further insertions

Declaration of competing interest

The author has no conflicts of interest to declare.