A Can of V8® Vegetable Juice Per Rectal Route

Abstract

Purpose: Rectal foreign bodies can be a difficult diagnostic dilemma especially due to the reluctance with which patients disclose history pertaining to them. Presentation is usually delayed because of the perceived stigma associated with rectal problems. A 78-year old gentleman presented with a three-day history of vomiting, abdominal bloating and fecal incontinence symptoms. The vomiting occurred with every meal and consisted of undigested food. He had history of two weeks of chronic diarrhea but stool studies had been negative. Abdominal exam was significant for generalized tenderness and distension, without rebound or peritoneal signs. Digital rectal examination revealed a rock-hard but smooth surfaced mass deep in the rectal vault. A computed tomography scan revealed a distended rectum with “massive amounts of fecal material” and a “cylindrical object in the rectal pouch with an air-fluid level within the object”. Fecal disimpaction with digital manipulation was unsuccessful. The patient was re-interviewed but denied inserting any foreign body through his anus. Patient was taken to the operating theatre where the object was extracted under general anesthesia and found to be a 12 oz Can of V8® vegetable juice. The patient did not suffer any complications of perforation and his gastrointestinal symptoms resolved within the next 48 hrs. He was offered psychological support post-op which he accepted. This case serves to illustrate that very few people with anorectal foreign bodies will freely admit to trans-anal introduction.(1) In the referenced case, a digital rectal examination and radiological evaluation proved invaluable in clinching the diagnosis. As with our patient, offering psychological support without passing judgment is an important part of the post-extraction management.(2)Figure. V8: ® vegetable can in rectum.