Throw a bone here: an evil and rare consequence of foreign body passage.

Abstract

Dear Editor: The authors report a case of a 54-year-old woman who was admitted in the emergency department due to severe anal pain. She referred that this pain started after she had eaten chicken bones 4 days before. She also complained of obstructed defecation and the presence of small hard bones in the stools. The perianal area was ulcerated and very painful. On digital examination, small bones were palpable in the stools. No signs of perforation were found on the plain abdominal radiograph. A proctosigmoidoscopy showed stools with multiple small bone fragments in the rectum (Fig. 1) and signs of ischemia of the distal rectum and anal canal mucosa due to the previous impaction of these fragments (Fig. 2a, b). Some large bones were removed during proctosigmoidoscopy, but it was impossible to remove all. The patient was admitted in the surgical ward, and symptoms progressively improved, with subsequent mucosa healing and passage of the bones in the stools. She was discharged 5 days later. Rectal foreign bodies often represent a difficult diagnostic and management dilemma. Although the majority is inserted through the anal canal, in rare cases, it results from an orally ingested object that becomes impacted in the rectum [1]. Patients may be asymptomatic or present with abdominal pain, rectal bleeding or pain, and constipation. Though most objects pass without incident, complications can arise following ingestion of foreign body. Ischemia of the rectum is very rare due to its extensive collateral blood supply, but hard objects pressing constantly against a particular area of the bowel wall may decrease the capillary perfusion pressure and, if prolonged, it may induce ischemic lesions [2].