It’s All Good in the Hood: An Innovative Technique for Rectal Fish Bone Extraction

Abstract

Introduction: Rectal foreign bodies are a relatively rare entity; examples include plastic/glass bottles, cucumbers, carrots, or rubber objects. Swallowed objects such as fish bones are occasionally found in the rectum; those that do not pass with the stool have a tendency to develop complications including intestinal perforation, enterovesical fistulas, and perianal abscesses. Previously reported rectal foreign bodies have been removed transanally with anal dilation and via laparotomy. We present an unusual case where a fish bone was successfully removed from the rectum endoscopically using a foreign body hood protector. Case Report: A 46-year-old male with a past medical history of hypertension, diabetes, and hemorrhoids presented to the ED of our facility with rectal pain 4 days after swallowing a fish bone. Four days prior to presentation, a butterfish got “stuck” in the patient’s esophagus, which eventually passed with copious liquid ingestion. The patient attempted to relieve his rectal pain with hemorrhoidal suppositories without improvement. Vitals were stable in the emergency department, and abdominal exam was unremarkable. A sharp linear object was felt along the wall of the anal canal on rectal exam upon which the emergency department physician reported cutting her finger. An abdominal x-ray demonstrated a linear opacity in the rectum approximately 2 cm in size with no evidence of obstruction or perforation. A thin, flat triangular bone with sharp tips and lateral projections was visualized laying against the mucosa during flexible sigmoidoscopy. The bone was gently maneuvered into the rectum with the endoscope and was safely removed using rat tooth forceps and a foreign body hood protector to protect the anal canal. No mucosal tears or perforations occurred; the patient was discharged home without complications. Discussion: The foreign body hood protector is a small bell-shaped latex rubber protector that was designed to be placed over an endoscope in a folded back position to protect the mucosa of the gastrointestinal (GI) tract from the sharp edges of a foreign body during its removal. This rubber hood is generally used to protect the esophagus and posterior pharynx during foreign body removal from the upper GI tract. Case reports have demonstrated successful rectal foreign body, such as fish bone, removal transanally with anal dilatation. This case is unique as it demonstrated the successful endoscopic rectal fish bone removal just by thinking “out of the box.”