TMI Friday: An Unusual Rectal Injury

The year was 1953, it was the fifth of November and a 24 year old man stumbled into Beckett Hospital complaining of abdominal pains. He told the doctors that it was a regular occurrence, that he had been plagued by abdominal pain for the past ten years. He told them that the evening before, he had noticed blood issuing from his bowels, and that he had vomited that morning.

As the doctor noting his horribly swollen and tender belly, he fainted.  This made finding the source of the problem more difficult. The doctor checked for tumours, and ended up trying to perform a proctoscopy. This involved the insertion of an instrument known as a proctoscope up the anus in order to get a look at the inside of the rectum. However, the copious amount of blood and faecal matter belching from the anus made it impossible to see anything.

This called for more drastic measures. The patient was anaesthetised, and the abdomen was opened up to get some idea what was going on. The abdominal cavity was full of blood, that was likely caused by some form of internal bruising. In the absence of an obvious injury, the abdomen was closed up. The doctor took another examination of the rectum, which was easier now that the patient was sedated, and found the source of the bleeding, a three cm rip in the rectum. With this established, surgery was performed to heal the wound, and to reverse the damage. But an important question still remained.

How did this injury occur ? Clearly, the patient had not told the whole story about what had happened to him. The three centimetre rip was clearly caused by a traumatic injury. The patient admitted this, and then gave them another explanation for what happened.

It was the fifth of November, Bonfire night, where the English stage fireworks displays to celebrate the foiling of the gunpowder plot. The man said that he had bent over at the wrong moment, and a carefully aimed firework had shot up his anus.

But this story didn't make sense. There would be damage to the anal sphincter and the butt cheeks had this been the case. When confronted with this evidence, the man told them a third story. I shall now quote directly from the article.

For domestic reasons he had become unhappy and morose, and on the evening of November 4 he decided to explode a firework up his seat. He accordingly fashioned a narrow tube, using cartridge paper, and with the aid of a pencil introduced one end of this tube, approximately 6 inches (15cm.) in length, into his rectum. He then placed a lighted firework into the end of the tube projecting out of his anus...

This story still left the question as to where the firework went, as no fragments were found. and there was a distinct lack of singeing. It is possible that the sheer volume of effluence issuing from the anus could have washed out the bits of firework. The patient maintained their story under psychiatric evaluation, so we must assume that this was the true story.There is no escaping the image of a man not only lighting a firework up his own anus, but then hitching up his pants and waiting until the next day to actually go to hospital.
The frustrating thing about this tale is that the patient went to some length to deceive the doctors with a fake medical history. Had he told the doctors the truth, he would have been put under anaesthesia, and have been treated more rapidly. That is one of the lessons we can draw from this study, aside from the obvious one.


Butters A.G. (1955). Unusual Rectal Injury, The British Medical Journal, 2 (4939) 602-603. DOI: 10.1136/bmj.2.4939.602