An 11-year-old boy’s classmate put a pencil, point up, on his chair as a prank. When the boy sat down the pencil impaled his left buttock, all the way in.

[u/CatPooedInMyShoe]

[u/CatPooedInMyShoe]

This case is out of the United Arab Emirates:

An 11-year-old previously healthy boy arrived at the emergency department after a penetrating injury to the left buttock at his school. According to the patient and school staff, a classmate had placed a pencil upright on a chair as a prank, and the patient unknowingly sat on it, resulting in a penetrating wound to the left buttock.

Upon arrival at the emergency department, the patient was alert and hemodynamically stable. Vital signs showed a blood pressure of 115/78 mmHg, a pulse of 82 bpm, a temperature of 37°C, a respiratory rate of 24 breaths/minute, and an SpO₂ of 98%, all within normal limits. Physical examination revealed a puncture wound in the inferomedial aspect of the left gluteal region with no active bleeding or neurological or vascular compromise. The abdominal exam showed a soft, non-distended abdomen with normal bowel sounds. The digital rectal exam was delayed due to concerns for rectal involvement.

Laboratory tests at presentation showed a normal hemoglobin level of 12.7 g/dL (reference: 11.5-15.5 g/dL), a white blood cell count of 9.8×10⁹/L (reference: 5.0-13.0 ×10⁹/L), and a creatinine level of 0.47 mg/dL (reference: 0.52-0.69 mg/dL) (Table 1).

CT pelvis with contrast revealed an elongated hyperdense foreign object measuring 12.4 cm × 6.7 mm traversing the ischiorectal and ischioanal fossae, with the tip seeming to penetrate the posterior rectosigmoid bowel wall and lie intraluminally. There was no evidence of free fluid, air in the peritoneal cavity (pneumoperitoneum), or vascular injury. Coronal CT imaging showed an elongated foreign object penetrating from the gluteal region toward the posterior rectosigmoid wall (Figure 1). The sagittal CT view demonstrated the tip to be intraluminal in the rectosigmoid colon (Figure 2). In addition to standard CT scans, a 3D volume-rendered CT reconstruction was performed, which provided a clearer view of the course and depth of the foreign body in relation to the bony pelvis and soft tissue structures (Figure 3).

A multidisciplinary team involving pediatric surgery and gastroenterology recommended diagnostic laparoscopy and colonoscopy. The patient's father provided informed consent. Under general anesthesia, laparoscopy showed no signs of perforation, contamination of the peritoneum, or bowel contents spillage. Colonoscopy revealed intact mucosa across the rectosigmoid junction. The pencil was then carefully removed through the gluteal entry wound. No active bleeding was observed. The wound was cleaned and dressed in a regular gauze, and the abdomen was reinspected before port closure.

Postoperatively, the patient was kept on nil per oral (NPO) and started on intravenous piperacillin-tazobactam and metronidazole. On day two postoperatively, he began experiencing abdominal discomfort and mild hypotension (BP 90/50 mmHg). Inflammatory markers appeared elevated: CRP 211 mg/L (reference: <5 mg/L) and WBC count of 17.9×10⁹/L (reference: 5.0-13.0 ×10⁹/L). Abdominal ultrasound showed a retrorectal collection measuring approximately 16-20 mL with internal debris. Follow-up imaging later revealed the collection increased to 30.45 mL (6.5 × 2.5 × 3.46 cm) (Figure 4). As the child remained stable after adequate hydration, he was managed conservatively. The surgical team decided to observe the CRP trend, as procalcitonin was mildly elevated at 0.6 ng/mL (reference <0.5 ng/mL), and the child was responding well to antibiotics.

By day five postoperatively, the patient's abdominal symptoms had subsided. Oral intake was resumed, and the patient tolerated it well. A repeat ultrasound showed a reduction of the collection to 2.7 × 2.6 × 1.4 cm. He was discharged on oral antibiotics and paracetamol. During follow-up after one week of discharge, he was asymptomatic, and an ultrasound revealed complete resolution of the retrorectal collection. Complete wound healing was observed, with no signs of infection.

[u/TheWhiteRabbitY2K → u/CatPooedInMyShoe]

Nice to get the whole story. I need to save this to traumatize my future child when I scold them on the dangers of horseplay.

[u/hitsomethin → u/TheWhiteRabbitY2K]

We don’t prank. I’ve been telling my kid that. No pranks. They’re never funny to the person being pranked; and the risk of it turning out way worse than intended, like this, outweighs any potential humor.

[u/BuckeyeBentley → u/hitsomethin]

And that's why you never prank your friends!

[u/HazardousPork2 → u/BuckeyeBentley]

He is all left.

[u/SiegelOverBay → u/hitsomethin]

There are harmless pranks, which hurt no one and everyone can laugh afterwards. Stuff like bubble wrap under the bathmat, stuffing the toes of someone's shoes with paper, shortsheeting someone's bed, etc. My mom lowkey encouraged this kind of stuff because it takes creative thinking to find a new way to harmlessly surprise someone.

[u/ObsessiveRecognition → u/hitsomethin]

Pranks are hilarious.

This was not a prank, this was some dipshit kid being a dipshit kid.

[u/_qua → u/CatPooedInMyShoe]

Zosyn + metronidazole!

[u/Forward-Razzmatazz33 → u/_qua]

Yeah, nuts.

[u/Crazy-Marionberry-23 → u/_qua]

NAD- but uhhh yeah my tummy would be upset after that too

[u/thegreatestajax → u/CatPooedInMyShoe]

Why don’t people ever involve radiologist in the write ups? The imaging description is terrible. No one would separately describe something by each of three imaging planes.

[u/minecraftmedic → u/thegreatestajax]

Maybe that is the radiology report, and the radiologist just writes really waffling reports?

I prefer to write my CT reports as Haikus. If you can't say in in 3 lines it's probably not relevant.

Pencil in his butt

The tip's perfed his rectal wall

No free fluid or gas

[u/tink12mrw → u/minecraftmedic]

This was amazing. I want to read more of your reports!

[u/minecraftmedic → u/tink12mrw]

Glad you enjoyed lol.

[u/Mediocre_Ad_6020 → u/minecraftmedic]

Please come work at my hospital

[u/sasstermind → u/thegreatestajax]

yeah i mean it’s not like the radiologist provides their own write up with the scan anyway right??? /s

[u/KumaraDosha → u/CatPooedInMyShoe]

A case in which the ultrasound exam was actually needed. I could only dream of getting to be so useful.

[u/Omarinoo → u/CatPooedInMyShoe]

If there was an infection disease specialist involved he needs to be fired zosyn + metronidazole is by far one of the most redundant regimens I have ever seen