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A 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-affected cut in her stomach with a 30 cm kitchen knife. Vital parameters were intact and there were no traumatic findings 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.

The most striking finding at computed tomography scan was the total absence of the small bowel, later confirmed during surgery (Figure 1). The 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. The missing pieces were brought to the hospital but unfortunately were not found to be viable and replacement was considered futile (Figure 2).

Figure 1
figure 1

Abdominal computed tomography image showing the total absence of the small bowel.

Figure 2
figure 2

Pieces of bowel, cut into pieces during removal. Several pieces of bowel, cut into pieces during the removal procedure, were found by the police in the surroundings of the patient's house.

Notorious is the Japanese ritual suicide known as harakiri (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].

The ancient Egyptians believed that toxins formed as a result of decomposition within the intestines. This 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 Disembowelment' by Devourment, with lyrics such as 'I must release these vile insects from inside of me' - although the lyrics as a whole are quite difficult 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-inflicted 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 problems, transplantation would be unfeasible and the expectation is that she will be dependent on lifelong parenteral feeding.


  1. Osumi M: Seppuku no rekishi. Tokyo: Yusankaku; 1973. [History of seppuku]

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  2. Devourment - Self Disembowelment[]

  3. Wayne Carter Threw Intestines at Officers after Stabbing Himself, Police Say[]

  4. Watanabe T: Atlas of Legal Medicine. Philadelphia: J.B. Lippincott Company; 1968.

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  5. Abu-Elmagd KM, Kosmach-Park B, Costa G, Zenati M, Martin L, Koritsky DA, Emerling M, Murase N, Bond GJ, Soltys K, Sogawa H, Lunz J, Al Samman M, Shaefer N, Sindhi R, Mazariegos G: Long-term survival, nutritional autonomy, and quality of life after intestinal and multivisceral transplantation. Ann Surg 2012, 256: 494. 10.1097/SLA.0b013e318265f310

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The study complies with the Declaration of Helsinki and good clinical practice guidelines. The patient gave permission to publish this manuscript.

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Correspondence to Walter M van den Bergh.

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The authors declare that they have no competing interests.

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van den Bergh, W.M., van Westerloo, D.J. & de Jong, V.M. Self-disembowelment. Crit Care 17, 403 (2013).

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