Abstract
BackgroundDiagnostic and therapeutic instrumentation of the lower gastrointestinal tract has been reported to result in bacteremia and endocarditis. No such case has been reported in persons with a history of rectal foreign body insertion despite its potential for greater trauma.Case presentationA 58-year-old male was admitted with confusion and inability to speak. His past history was notable for hospitalization to extract a retained plastic soda bottle from the rectosigmoid two years prior. On examination, he was febrile, tachycardic and hypotensive. There was an apical pansystolic murmur on cardiac examination. He had a mixed receptive and expressive aphasia, and a right hemiparesis. On rectal examination he had perianal erythema and diminished sphincter tone. Magnetic resonance imaging of the brain showed infarction of the occipital and frontal lobes. Transesophageal Echocardiography of the heart revealed vegetations on the mitral valve. All of his blood culture bottles grew methicillin sensitive Staphylococcus aureus. He was successfully treated for bacterial endocarditis with intravenous nafcillin and gentamicin. The rectum is frequently colonized by Staphylococcus aureus and trauma to its mucosa can lead to bacteremia and endocarditis with this organism.In the absence of corroborative evidence such as presented here, it is difficult to make a correlation between staphylococcal endocarditis and anorectal foreign body insertion due to patients being less than forthcomingConclusionThere is a potential risk of staphylococcal bacteremia and endocarditis with rectal foreign body insertion. Further studies are needed to explore this finding. Detailed sexual history and patient counseling should be made a part of routine primary care.
Highlights
Diagnostic and therapeutic instrumentation of the lower gastrointestinal tract has been reported to result in bacteremia and endocarditis
There is a potential risk of staphylococcal bacteremia and endocarditis with rectal foreign body insertion
There is a large body of surgical literature reporting anal eroticism resulting in rectal trauma and retained foreign bodies [1,2], but there is no report of bacteremia or endocarditis occurring in these patients
Summary
There is a large body of surgical literature reporting anal eroticism resulting in rectal trauma and retained foreign bodies [1,2], but there is no report of bacteremia or endocarditis occurring in these patients. A closer examination of his medical records revealed that two years prior to this hospitalization, the patient was admitted with a plastic soda bottle retained in the rectosigmoid for 3 days. The patient was taken to the operating room and under spinal anesthesia the bottle was extracted He had multiple lacerations of the rectal mucosa but there was no perforation. The patient's history of anorectal insertion of a plastic soda bottle for sexual gratification is consistent with published reports of use of large objects for this purpose [7]. In a study of gastrointestinal colonization, Staphylococcus aureus grew from the culture of rectal swabs in 60% cases versus 53% positive culture of nasal swabs taken from the same subjects [10] This organism is known to cause endocarditis of normal heart valves [11,12]. A further study of patients with well-documented evidence of rectal foreign body insertion could be the step to explore this important observation
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