A 67-year-old man with Down syndrome with intellectual disability presented with fever and cough. He denied abdominal pain or any change in bowel movement. His abdominal examination was unremarkable. A contrast-enhanced CT of the chest and abdomen performed for the fever work-up incidentally revealed a sharp-edged foreign body in the rectum without perforation (figure 1, online supplementary video). A colonoscopy disclosed a conch shell, 5 cm in length, …