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A 35-year-old woman with bipolar disorder was found wandering on a highway screaming and crying, with disorganized speech. She was evaluated in the emergency department, and computed tomography of the head revealed a hypodense area. The patient reported that she had a nail in her uterus. In the context of the presentation, this was deemed to be unlikely. However, before magnetic resonance imaging was performed for further evaluation, radiography of the abdomen showed a large nail, which was localized to the bladder on ultrasonography, and an intrauterine device in the uterus. Surgery was scheduled to remove the nail, but on the morning before surgery, the patient painlessly passed a 10-penny 8.3-cm steel nail while voiding. After resolution of this psychotic episode, the patient revealed that her intention was to place the nail in her uterus as a means of protection against being raped, which had occurred in the recent past. She was subsequently admitted to a psychiatric facility.
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