1868 Novel Use of Overtube for Rectal Foreign Body to “Clean” Out the Colon: Extraction of Large Tide-To-Go Pen

Abstract

INTRODUCTION: The rate of colorectal foreign bodies is rising. This poses an interesting challenge to endoscopists as there is great variability in object size, shape, and surface characteristics. This heterogeneity requires endoscopists to have a diverse range of techniques at their disposal to safely remove colorectal foreign bodies in a minimally invasive manner. We present a case of the novel use of an esophageal overtube to aid in the removal of a difficult-to-remove Tide To Go cap. CASE DESCRIPTION/METHODS: The patient was a 55-year-old male who presented to the ED about 24 hours after inserting a smooth plastic Tide To go pen into his rectum. When he attempted to remove the pen, the cap was left behind. He denied any pain, hematochezia, fevers or chills. In the ED he underwent a CT scan which showed a well circumscribed air-containing elongated and conelike region occupying the rectum and rectosigmoid with mild thickening of the rectal wall without extraluminal air. We initially gave him 4L of Golytely to flush the object, but he did not pass the object on his own. During flexible sigmoidoscopy we could appreciate a very strictured and erythematous rectum and a smooth, white, plastic object lodged in the rectosigmoid colon. Multiple attempts at pulling the object out with rat-tooth forceps, snare, and Roth net were all futile as we could not pull the object through the narrowed rectum. We then inserted a heavily lubricated esophageal overtube through the rectum and pulled the object into the overtube and removed the cap and overtube together. The overtube helped dilate and straighten the rectum while allowinging the object to be secured into the overtube. DISCUSSION: The incidence of patients presenting to emergency departments with rectal foreign bodies is increasing, particularly in males. Recurrent episodes of rectal foreign body insertion requiring repeat endoscopic and surgical interventions for extraction can lead to anorectal stricturing. The alteration of anatomy may, as in this case, result in difficulty with foreign body extraction despite endoscopic access to the object. Stenting of the overlying mucosa and straightening of the rectum with overtube placement may facilitate successful retrieval of the rectal foreign body.