The X-ray taken by staff at AAST Grand Hospital in Milan (we added the arrows). Tringali, A. et al./BMJ Case Reports, 2018

Medical professionals are well-versed in removing large objects from people’s rectums. As the dozens of published case reports and thousands more back-office anecdotes will attest, humans love testing the limits of what will fit in that part of their body, but seem to forget sometimes that taking it out might present a different set of difficulties. It is thus up to emergency room staff and gastrointestinal experts to remedy the situation, and many years of on-the-spot troubleshooting has led to the development of numerous extraction tricks and techniques.

Now, a team of physicians at the AAST Grand Hospital in Milan have added a new tool to the arsenal after a particularly challenging instance forced them to innovate. Writing in BMJ Case Reports, endoscopist Dr Lorenzo Dioscoridi and his colleagues detail the treatment of a 31-year-old man who presented to the emergency room with a girthy, 60-centimeter (23 inch) rubber dildo lodged inside him.

During the initial examination and questioning by the staff on duty, the man explained that the toy was "not removable by hand" and had been stuck for 24 hours. Yet, other than some mild abdominal pain, he was feeling fine. When an X-ray revealed the sheer magnitude of the problem, he was referred to the endoscopy unit.

The full X-ray image. Tringali, A. et al./BMJ Case Reports, 2018

Dr Dioscoridi’s team then tried multiple standard approaches to remove the item from the terminal colon, including snaring it with a wire loop device that is otherwise used to remove polyps, and displacing it with a dilating balloon then grabbing it with forceps.

But these attempts all failed due to “the rigidity, the smoothness and the size of the object,” the physicians recalled. Hoping to avoid the last resort option of highly invasive surgery, they built a “home-made” device out of medical wire pushed through a stent tube. Unlike existing polyp snares, the team’s “guidewire lasso” was rigid enough to loop around the sex toy and pull it away from the colon walls.

The guidewire lasso created by Dr Dioscoridi and his colleagues. Tringali, A. et al./BMJ Case Reports, 2018

“We finally succeeded in the endoscopic extraction of the device, catching the distal edge of the dildo with this guidewire lasso,” Dr Dioscoridi and colleagues wrote.

“We suggest this new technique as a valid option to remove large foreign bodies from the colon and rectum when standard endoscopic methods for foreign body extraction fail.”

In addition to advancing the field of foreign body removal, this tale has a happy ending for the patient. He was able to return home the same day as the extraction and suffered no lasting symptoms. According to the report, he wrote the physicians a thank-you note expressing his appreciation that they could solve his “embarrassing problem” without an operation.