48Accid Emerg Med 1999;16:418-421 Body piercing in the accident and emergency department Rakesh Khanna, S Sathish Kumar, B Srinivasa Raju, A V Kumar Abstract Recently an increasing number of patients with complications related to pierced body jewellery have been seen. Often removal of the jewellery is indicated. Removal of these items may also be required for radiological purposes. If the doctor is familiar with the opening mech- anism of the item, removal is not usually difficult. Uninformed attempts at removal may cause unnecessary trauma and dis- tress. In a survey of 28 accident and emer- gency doctors, only six were able accurately to describe the opening mecha- nisms of all three commonly used types of jewellery. Descriptions of the types of jew- ellery currently used are not available in the medical literature. The aim of this article is to familiarise doctors with the types of jewellery used, describe their opening mechanisms, and suggest tech- niques for their removal. The complica- tions of body piercing and the indications for the removal of body jewellery are also outlined. (7Accid Emerg Med 1999;16:418-421) Keywords: body piercing; jewellery Accident and Emergency Department, Staffordshire District Hospital, Stafford R Khanna S S Kumar B S Raju A V Kumar Correspondence to: Rakesh Khanna, Specialist Registrar in Accident and Emergency, 289 Birmingham Road, Sutton Coldfield B72 IED. Accepted 28 July 1999 Over the last few years body piercing has become an increasingly popular expression of body art. Increasingly the vogue is for piercing and placing body jewellery in unconventional parts of the body such as the tongue, lips, labia, and even through the erectile tissue of the penis, nipple, and clitoris. These patients may present to the accident and emergency (A&E) department with a variety of complications and it may be necessary for the jewellery to be removed in the department. Because the jewel- lery is radio-opaque removal may be required for standard radiography. This is especially important when cervical spine views are required in a patient with a "lingual bar" which may obscure the odontoid peg. They may also require removal to prevent scattering of computed tomographic scans and disturbance of the magnetic field when performing mag- netic resonance imaging. There are several reports of the complica- tions of body piercing in medical literature including local and systemic infections,' 2 the possible transmission of hepatitis B and HIV,3 Ludwig's angina,5 and toxic shock syndrome.6 Dental journals have documented the compli- cations of intraoral piercing.' 8 There have also been reports on significant local granuloma- tous reactions.9'-1 The commonest complica- tions are almost certainly bleeding, local infec- tion, and oedema of surrounding tissues leading to embedding of the jewellery. We have seen a number of patients in our department with a variety of minor complica- tions relating to body jewellery requiring its removal (box 1). Some difficulty was experi- enced in effecting this, prompting us to research this area. In the medical literature, there did not appear to be any detailed descriptions of the various types of studs and rings used by practitioners of this art nor of their opening mechanisms. The aim of this article is to outline the various types of body jewellery in use today, describe their opening mechanisms, review the potential complica- tions of this "art form", and to suggest appro- priate techniques to remove them in some of the different situations that may be encoun- tered in an A&E department. Out of 28 A&E doctors surveyed, only six were able accurately to describe the opening mechanism of the three common types of jew- ellery shown in fig 1. Four doctors suggested unnecessary procedures such as incising of the surrounding tissue. This article addresses this deficit in information. We interviewed four licensed body piercing practitioners who we questioned with regard to their licensing requirements and techniques used. We also procured a range of stainless steel body jewellery to dismantle, study, and photograph. The medical literature was re- viewed in Medline using the OVID interface from 1986 to January 1999 for all entries relat- ing to body piercing. Techniques used by "professional piercers" Licensed ear piercers usually carry out body piercing in the UK. The environmental depart- ment of the local council, which accesses the training of the applicant, vets them. The Body Piercing Association conducts training courses. After inspecting the proposed premises and ensuring that arrangements are Figure 1 Example of types of body jewellery. (A) Barbell stud; (B) labret stud; (C) captive bead. 418 group.bmj.com on June 23, 2017 - Published by http://emj.bmj.com/ Downloaded from