EP.TU.226Removal of a pepper shaker from the rectum using a Foleys catheter, a novel technique of balloon trawling

Abstract

Abstract Background Foreign bodies inserted into the rectum often pose a challenge to the emergency surgical teams due to the unforthcoming nature surrounding the object inserted. Its shape, size and the position within the rectum and the associated bowel and sphincter injuries often determine the route of extraction and the need for further intervention. Trans-anal extraction risks anal sphincter injury, however, circumvents the need for a laparotomy and a potential stoma. Case history Here we describe a case of a ceramic pepper shaker inserted into the rectum of a 41-year-old male. Removal was undertaken under general anaesthesia and required evaluation of the matching salt shaker in theatres to creatively design a manoeuvre to extract the shaker via trans-anal route without risking it breaking inside the rectum. Methods A 20 French Foleys catheter was of an appropriate size to be able to thread through the opening at the bottom of the salt shaker. Under optical sigmoidoscopic guidance, the catheter was inserted into the rectum and passed through the hole in the bottom of the pepper shaker. The balloon of the Foleys catheter was then inflated with 30ml of saline and trawled out of the rectum intact. Conclusion Extraction of foreign bodies via trans-anal route in most instances avoids prolonged morbidity. Successful removal of these difficult foreign bodies with minimum morbidity often requires strategic planning and creative thinking.