Abstract
BackgroundEntrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault.MethodsBetween 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients.ResultsAll patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died.ConclusionsForeign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body.
Highlights
Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice
We made a post extraction protocol that consisted of observation, repeat abdominal physical examination, a flexible rectosigmoidoscopy and repeat plain films to examine for evidence of injury and perforation that may have occurred during the extraction process
Most of the patients were admitted to emergency room with complain of rectal bleeding, anorectal pain In one of our cases, the patient presented with hypotension, fever, tachycardia, tachypnea and abdomino-pelvic pain that lead the suspect of acute abdomen due to perforation
Summary
Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Entrapped foreign bodies are most often related to sexual behavior, they can result from ingestion or sexual assault. Rectal foreign body insertion has been sporadically described in published reports. Colorectal foreign bodies (CFBs) are not an uncommon presentation to the emergency or colorectal surgery department, and some authors have suggested that the incidence is increasing [1]. Rectal foreign bodies often pose a challenging diagnostic and management dilemma that begins with the initial evaluation in the emergency department and continues through the postextraction period. Objects can be inserted in to the rectum for diagnostic or therapeutic purposes, self-treatment of anorectal disease, than truthful regarding the reason for their visit, leading to extensive workups and further delays [4]. A stepwise approach that includes diagnosis, removal and postextraction evaluation is essential [4]
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