A brief forewarning: please refrain from sticking dumbbells in your bodily orifices. It will not end well. There are adult toys specially designed for this purpose and they will not land you in the ER - or in the pages of a medical journal. 

A man in Brazil faced this predicament when a metallic, 20cm-long, 2kg dumbbell became lodged in his rectum and had to be removed by a surgeon. 

According to the International Journal of Surgery Case Reports, the 54-year-old patient arrived at the emergency department after suffering two days of abdominal pain, cramping, nausea, vomiting and constipation.

Following a physical examination and abdominal radiography, the doctors discovered "evidence of the presence of a foreign body in the shape of an exercise dumbbell" lodged where the colon meets the rectum.

According to the case report, the man then admitted to an "accident" in which the dumbbell had become stuck inside him after insertion, and said he had already attempted to remove it himself to no avail. As the patient was in a stable condition with no signs of perforation, he was taken to the operating room and an anaesthetic was administered. 

A doctor then attempted to remove the dumbbell, but encountered difficulties due to its position, with the report noting that the weight was too far up to be extracted with tweezers or other grasping instruments. 

As a result, the surgeon opted for "manual extraction" without tweezers. Yes, that means the doctor had to physically insert their forearm into the man's rectum - "with some difficulty" - to remove the weight.

The patient remained in post-anaesthetic recovery for four hours and was referred to the general surgery ward. He remained hospitalised for three days without post-extraction complications and was discharged on the fourth day.

"Insertion of foreign bodies via the rectum [and] retained rectal objects are a rare complaint in the emergency department, but an increasingly important occurrence in recent years," the researchers said in their report.

The case report also noted that "insertion and retainment of foreign bodies" via the rectum predominantly affects white males between the ages of 20 and 40, with the objects most commonly inserted for sexual pleasure. 

"Despite being a rare complaint in the routine of emergency and having no defined incidence, cases of rectal foreign bodies have increasing numbers, mainly due to auto-erotic causes," the researchers added.

"Despite being a problem that affects both genders, in the literature consulted there is a predominance of males... specifically white men between 20 and 40 years old, having practices of sexual gratification as the greatest motivation.

"A huge variety of rectal objects have been described, with a greater predominance of those of a sexual nature, followed by glass objects, which should be handled with greater care due to their fragility and risk of injury if broken.

"Patient assessment is usually difficult due to the patient's fear during the history, as he tends not to report what happened objectively. The clinical history can be confusing, due to the patient's fear of reporting the complaints. 

"Generally, most patients, because of embarrassment, only present for medical attention after several unsuccessful attempts to remove the object alone, resulting in an average calculated delay of 1.4 days to seek help. Many of them have nonspecific complaints of lower abdominal pain... so it is up to the examiner to maintain high suspicion and take a careful approach to reach the diagnosis."