The Misplaced Shoe Polish Bottle!

Abstract

Rectal foreign bodies of various shapes and sizes have been reported. Such patients usually present with pain and obstructive symptoms however presentation is often delayed due to embarrassment. Morbidity is due to bleeding, laceration or perforation and is usually complicated with multiple attempts at self removal. We present the case of a patient with a considerably large foreign body impacted proximal to the rectosigmoid junction which was successfully removed by endoscopy. Case Presentation: A 43 y man presented with rectal pain and mild rectal bleeding for two days. He admitted to using objects for rectal insertion two days prior to presentation. The patient had made several unsuccessful attempts to evacuate the rectum using digital manipulation and laxatives. On rectal exam, the smooth edge of a foreign body was palpable. Abdominal xray was suggestive of a metallic spring device in the sigmoid. Sigmoidoscopy revealed the base of a large plastic bottle at 5 cm from the dentate line [Fig. 1]. The scope was carefully advanced along the side of the bottle and its proximal end was noted to be at 30 cm. Attempts to grab the bottle with forceps of various sizes were unsuccessful. It was also not possible to snare the bottle as its diameter was larger than the largest available endoscopic snare. Finally, 9.5 in Foerster forceps with serrated jaws were inserted carefully alongside the scope and under visual guidance, the base of bottle was grasped. The forceps were slowly pulled out as the patient bore down. The object turned out to be a plastic liquid shoe polish bottle 20 cm long and 4.5 cm in diameter. A check sigmoidoscopy revealed minimal mucosal trauma at the rectosigmoid junction but no perforation. Repeat abdominal xray was normal and the patient discharged after observation for a few hours. Review of literature revealed this to be a unique case of a liquid shoe polish bottle recovered from the rectum using endoscopy. Discussion: Transanal removal of large objects impacted above the rectosigmoid junction is difficult. However, endoscopic removal should be preferred and attempted prior to open surgical approach as it is safe, less morbid and cost effective.[figure1]Figure