Spontaneous Expulsion of Rectally Inserted Tramadol Ampoules: An Unusual Case Report of Drug Concealment and Delayed Disclosure.

Concealment of illicit drug ampoules is an unusual clinical scenario, posing diagnostic and management challenges due to delayed disclosure, drug leakage risk, and retrieval difficulties. We present the case of a 28-year-old male, an intravenous drug user, brought from police custody with complaints of per rectal pain. After initial denial, he admitted to rectal insertion of six tramadol ampoules. Clinical examination and imaging confirmed the presence of foreign bodies in the rectum. While surgical removal was planned, spontaneous expulsion occurred without complications, as verified by postoperative imaging. This case underscores the importance of early suspicion, detailed history-taking, and prompt imaging in suspected rectal foreign bodies. In stable patients, conservative management with laxatives may allow safe natural expulsion, reducing the need for invasive intervention, as in this case; however, this should be seen as a positive outcome rather than a recommended management approach, especially in cases involving fragile drug-containing ampoules.