Self-disembowelment

case of self-disembowelment is presented with an overview of self-disembowelment as a cultural entity. A 26-year-old Chinese woman was found by alarmed paramedics outside her house while attempting to remove her bowels through a self-aff ected cut in her stomach with a 30 cm kitchen knife. Vital parameters were intact and there were no traumatic fi ndings apart from a small left paramedian cut of approximately 5 cm in her upper abdomen. She was confused, and even in the shock room the patient proceeded with her attempts to remove her bowels. Th e most striking fi nding at computed tomography scan was the total absence of the small bowel, later confi rmed during surgery (Figure 1). Th e police were contacted to see whether they could trace the missing bowels, and indeed several pieces of bowel, cut into pieces during the removal procedure, were found in the surroundings of the patient's house. Th e missing pieces were brought to the hospital but unfortunately were not found to be viable and replacement was considered futile (Figure 2). Notorious is the Japanese ritual suicide known as hara-kiri (spoken term) or seppuku (written term), which literally means 'cutting the belly' – the honorable method of taking one's own life practiced by men of the samurai (military) class in feudal Japan [1]. Th e ancient Egyptians believed that toxins formed as a result of decomposition within the intestines. Th is perception still exists, as evidenced by the plethora of advertisements for colon cleansing. In combination with the tough image of samurai committing seppuku, this leads to phenomena such as the Australian death metal band Disembowelment and songs such as 'Self Disembowel ment' by Devourment, with lyrics such as 'I must release these vile insects from inside of me' – although the lyrics as a whole are quite diffi cult to follow [2]. Rare examples of self-disembowelment include the report of a New Jersey man who allegedly cut out his entrails in front of police and then threw bits of his intestines at them [3]. Also, a case is mentioned in the 1968 edition of the Atlas of Legal Medicine [4]. As a result of her self-infl icted injury, our patient developed a short bowel syndrome for which intestinal transplantation has been advocated. However, survival rates and quality of life are better in patients on chronic parenteral nutrition [5]. Owing to ongoing mental Figure 1. …