Doll's Head "Bezoar"

Oh, yes, that does say doll's head bezoar, a tangled mass of indigestable material made up of a doll's head. You'd think that it would be obvious that a Barbie doll's head would be indigestable. And it was obvious to a 35-year-old man who last year ingested multiple doll's heads. On purpose. Most people won't be able to follow the link, so I've reprinted most of the article from the American Journal of Roentgenology. Pay special attention to the bold (my emphases).

A 35-year-old man presented with severe abdominal pain and distention but normal vital signs. An abdominal radiograph showed multiple rounded objects, some of which projected in the shape of a head with a pointed nose. Suspecting a case of "body packing", 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....

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

Motives for ingestion of foreign bodies vary greatly. 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, and patients seek medical help only if the passage is impeded at anatomic narrowings. Body packers smuggle illicit drugs (such as cocaine or heroin) in multiple ingested packages and may present as a toxicologic emergency with life-threatening symptoms caused by a leaking substance from a broken package. Rectal foreign bodies rarely come from ingestion but more commonly are the result of conscious insertion.

Radiographic detection of the characteristic nose and the unique features of the craniocervical junction of famous dolls 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.

Seriously, whatever happened to good old-fashioned auto-erotic asphyxiation?