1485 Rectal Foreign Body: A Novel Minimally Invasive Extraction Technique With Blakemore Tube

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INTRODUCTION: Rectal foreign bodies often pose a challenging diagnostic and management. They are usually classified as sharp or blunt and sexual or non-sexual. A few novel techniques described in literature to aid with extraction include Foley catheter, Blakemore tube, obstetrical forceps and vacuum extractor. We describe such a case of rectal foreign body extraction with Blakemore tube and flexible sigmoidoscopy, which saved the patient from an open surgical approach. CASE DESCRIPTION/METHODS: A middle-aged male presented to the Emergency room with complaint of inability to pass a rectal foreign body (cucumber) he had inserted into his rectum. He reported doing this on a regular basis and would usually remove them by bearing down. He did endorse any vomiting or abdominal pain and had been passing gas. A CT scan noted an elongated 23.5 × 4.9 × 4.7 cm foreign body in the rectosigmoid area with no bowel wall thickening or perforation with distal tip was 8.8 cm from the anal verge. Initial attempts at manual extraction by surgeon with exam under anesthesia were unsuccessful. An adult upper endoscope was inserted and used to guide a Blakemore tube under direct visualization beyond the proximal edge of the foreign body. The gastric balloon was inflated to 60 cc with saline and endoscope was withdrawn. Traction was applied by pulling the Blakemore and distal edge of cucumber was manually grasped and removed by the surgeon. Endoscopic re-inspection of the rectosigmoid colon confirmed no deep mucosal injury. DISCUSSION: This case demonstrates a few important principals which one should be cognizant of when managing large rectal foreign bodies. The most important factor in successful extraction is patient relaxation. Objects located more proximally in the rectum or the distal sigmoid colon may need a combined approach between gastroenterology and general surgery. A combined approach is also safer and minimally invasive, and able to save patient from an unneeded laparotomy. It is also important to re-evaluate the bowel mucosa for inadvertent injuries and perforations after successful removal of foreign body.