title: Suicide attempt by self-stabbing of the bladder: a case report.
abstract: BACKGROUND
  The presence of foreign bodies in the bladder often falls within questionable practices in psychiatric settings or in iatrogenic instances such as during endoscopy or migration of foreign bodies around the bladder remaining after surgery on organs close to the bladder. Psychiatric disorders have been reported in patients admitted for self-introduction of foreign bodies in the bladder during an act of sexual satisfaction. However, to the best of our knowledge, no similar case in the context of suicide has been reported in the English-language literature.
  
  
  METHODS
  A 56-year-old Moroccan man known to have untreated paranoid schizophrenia and a history of several previous suicide attempts was presented to the emergency unit of our hospital after self-stabbing with a 15 cm sewing needle. His stab wound was located at the hypogastric region of the abdomen, with full penetration of the needle into the abdomen. A computed tomographic scan showed a breach on the dome of the bladder responsible for extravasation of the contrast dye, which revealed a peritoneal cavity effusion of average abundance and a suspected lesion of the left pelvic ureter. An exploratory laparotomy was performed. Approximately 1000 mL of widely dispersed fluid was observed in the abdominal cavity. During exploration of the bladder, two centimetric intrabladder breaches were found, one of which was a breach of the left pelvic ureter without other associated lesions. The breaches were sutured, and a ureteral catheter was mounted. The patient's post-operative follow-up was unremarkable.
  
  
  CONCLUSIONS
  The wide variety of ways that foreign bodies are introduced into the lower urinary tract pose diagnostic and therapeutic difficulties for the urologist. Management of these patients is facilitated by the use of endoscopy.
authors.affiliation: Department of Urology, Hassan II University Hospital, Fez, Morocco. dr.kharbach@gmail.com.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Kharbach
authors.forename: Somuah
authors.initials: S
authors.lastname: Tenkorang
authors.forename: Mustapha
authors.initials: M
authors.lastname: Ahsaini
authors.forename: Soufiane
authors.initials: S
authors.lastname: Mellas
authors.forename: Jalaleddine
authors.initials: J
authors.lastname: El Ammari
authors.forename: Mohammed Fadl
authors.initials: MF
authors.lastname: Tazi
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Khallouk
authors.forename: Mohammed Jamal
authors.initials: MJ
authors.lastname: El Fassi
authors.forename: Moulay Hassan
authors.initials: MH
authors.lastname: Farih
mesh_terms: D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000293:injuries*; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000523:psychology*