A Complicated Case Of Foreign Body In The Rectum: A Case Report And Review
D Raje
Citation
D Raje. A Complicated Case Of Foreign Body In The Rectum: A Case Report And Review. The Internet Journal of Surgery. 2005 Volume 7 Number 2.
Abstract
Background: Foreign bodies in the rectum are a common occurrence encountered as a surgical emergency. Most cases can be managed by retrieval of object per rectum under anaesthesia using some ingenuity. However a few can be more difficult and require a laparotomy.
Aim: To report a complicated case of rectal foreign body treated at our institution.
Method: We reviewed our case and also extensive literature on this subject.
Case: A 29 year old woman presented with a vibrator in the rectum whilst being used for anal eroticism. She had lower abdominal discomfort but no signs of peritonitis. Attempt to remove it per rectum under anaesthesia failed
and a laparotomy was performed to retrieve the object.
Conclusion: Early recognition of problems in extraction per rectum is vital. Practice low threshold in proceeding to laparotomy to prevent anal or rectal injuries.
Introduction
The insertion of foreign objects into the anus and rectum is a well-known phenomenon. [1,2,3,4,5,6,7,8,9,10,11]. Treatment involves the careful retrieval of the offending object. It is essential to exclude any colorectal injuries, which if undetected can be lethal. Manual extraction can be difficult due to size, shape and migration of the foreign body.
Case Report
A 29 year old female presented with a 8 hour history of difficulty in removal of a battery operated vibrator introduced per anus for autoeroticism. At presentation she was only able to pass small amounts of flatus per rectum and complained of lower abdominal discomfort.
On physical examination she had lower abdominal distention and increased bowel sounds on auscultation but there were no signs suggestive of peritonitis. On digital rectal examination it was not possible to palpate the object although there was no blood on the examining finger to suspect injury.
Blood tests were normal and plain X-ray of the abdomen demonstrated the foreign body (see pictures 1 & 2).
Figure 1
Figure 2
Attempts to extract the vibrator per rectum under GA failed and a laparotomy and colotomy using a small left –sided Pfannensteil incision was performed to extract the object (see pictures 3 & 4).
Figure 3
Figure 4
Discussion
Foreign bodies in the rectum and colon are a well-described phenomenon most commonly seen in association with anal eroticism. Busch and Starling [12] reviewed the literature and revealed a plethora of foreign bodies, which have been removed from the rectum. These included a whisky bottle, a light bulb and a magazine. Marks [6] reported a pair of spectacles in the rectum of a 38-year-old man.
Factors which make extraction difficult include the size and shape of the foreign body. A large foreign body, such as the aerosol can, tumbler and a large vibrator in our case, can become impacted by the pelvic floor muscles or migrate higher up in the sigmoid colon. Chronicity may aggravate this. If the object is smooth and without a handle, it may be difficult to obtain a grip on it. This makes it difficult to exert external pressure. If retrieval is unsuccessful laparotomy is necessary [13,14,15,16].
Conclusion
Foreign bodies in the rectum and colon are quite common and most surgeons working in busy general hospitals will encounter such a patient at some point in his/her career. The diagnosis is confirmed by means of plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is usually only possible for very low lying objects. Patients with high lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. In the operating room the surgeon needs to use a certain degree of ingenuity and know when to perform a laparotomy.