Rectal Foreign Body Research Articles

Male Sexual Assault – A Case Report of Foreign Body in the Rectum from Sexual Assault by Female Partner

Most rectal foreign bodies (FB) are a result of insertion for sexual gratification. FB in the rectum as. result of sexual assault in males by the female partner is rare. A 32-year-ol man presented with a 6-day history of deep anal pain and lower abdominal pain, following an assault by a female partner while he was drunk. Physical examination and plain radiography confirmed a FB in the rectum. The FB was removed at exploratory laparotomy following failed attempt at trans rectal removal under spinal anaesthesia. The FB was confirmed to be a perfume canister. The patient has remained well at two months of follow up. Male sexual assault by female is not uncommon and can lead to disastrous effects. The female sexual assault on male is underreported and reported usually when there are complications. There is need to do more in-depth study to investigate the incidence of this.

A Case of Intra–abdominal Hemorrhage Resulting from a Rectal Foreign Body in Which Hemostasis Was Achieved Through Selective Transcatheter Arterial Embolization

A Case of Intra–abdominal Hemorrhage Resulting from a Rectal Foreign Body in Which Hemostasis Was Achieved Through Selective Transcatheter Arterial Embolization

Self Introduced Rectal Foreign Body in a 16-Year Old Boy: A Case Report and Review of Literature

Self Introduced Rectal Foreign Body in a 16-Year Old Boy: A Case Report and Review of Literature

A patient with a foreign body in the large intestine – a case report

Cases of patients with foreign bodies impacted in the terminal part of the gastrointestinal tract are rarely encountered in everyday surgical practice. Injuries and sexual practices are the most common aetiology of foreign body impaction in the lower gastrointestinal tract. Different types of surgical interventions are often needed in patients with anal or rectal foreign bodies. We describe a case of a 45-year-old patient who reported to hospital with the symptoms of low gastrointestinal obstruction. The man introduced a large foreign body into his anus during sexual play and was unable to remove it by himself. An attempt to remove the foreign body through the perineal access was made, but was unsuccessful due to the size of the impacted object. The patient was qualified for surgical treatment. Laparotomy was performed, and the foreign body was removed by a simultaneous use of abdominal pressure and extraction from the anal canal.

Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group

BackgroundRetained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion. MethodsTwenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or ≤48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative). ResultsAfter exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 ± 1; 2 [1-5] versus 5 ± 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management. ConclusionsAlthough partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified.

1485 Rectal Foreign Body: A Novel Minimally Invasive Extraction Technique With Blakemore Tube

INTRODUCTION: Rectal foreign bodies often pose a challenging diagnostic and management. They are usually classified as sharp or blunt and sexual or non-sexual. A few novel techniques described in literature to aid with extraction include Foley catheter, Blakemore tube, obstetrical forceps and vacuum extractor. We describe such a case of rectal foreign body extraction with Blakemore tube and flexible sigmoidoscopy, which saved the patient from an open surgical approach. CASE DESCRIPTION/METHODS: A middle-aged male presented to the Emergency room with complaint of inability to pass a rectal foreign body (cucumber) he had inserted into his rectum. He reported doing this on a regular basis and would usually remove them by bearing down. He did endorse any vomiting or abdominal pain and had been passing gas. A CT scan noted an elongated 23.5 × 4.9 × 4.7 cm foreign body in the rectosigmoid area with no bowel wall thickening or perforation with distal tip was 8.8 cm from the anal verge. Initial attempts at manual extraction by surgeon with exam under anesthesia were unsuccessful. An adult upper endoscope was inserted and used to guide a Blakemore tube under direct visualization beyond the proximal edge of the foreign body. The gastric balloon was inflated to 60 cc with saline and endoscope was withdrawn. Traction was applied by pulling the Blakemore and distal edge of cucumber was manually grasped and removed by the surgeon. Endoscopic re-inspection of the rectosigmoid colon confirmed no deep mucosal injury. DISCUSSION: This case demonstrates a few important principals which one should be cognizant of when managing large rectal foreign bodies. The most important factor in successful extraction is patient relaxation. Objects located more proximally in the rectum or the distal sigmoid colon may need a combined approach between gastroenterology and general surgery. A combined approach is also safer and minimally invasive, and able to save patient from an unneeded laparotomy. It is also important to re-evaluate the bowel mucosa for inadvertent injuries and perforations after successful removal of foreign body.

1868 Novel Use of Overtube for Rectal Foreign Body to “Clean” Out the Colon: Extraction of Large Tide-To-Go Pen

INTRODUCTION: The rate of colorectal foreign bodies is rising. This poses an interesting challenge to endoscopists as there is great variability in object size, shape, and surface characteristics. This heterogeneity requires endoscopists to have a diverse range of techniques at their disposal to safely remove colorectal foreign bodies in a minimally invasive manner. We present a case of the novel use of an esophageal overtube to aid in the removal of a difficult-to-remove Tide To Go cap. CASE DESCRIPTION/METHODS: The patient was a 55-year-old male who presented to the ED about 24 hours after inserting a smooth plastic Tide To go pen into his rectum. When he attempted to remove the pen, the cap was left behind. He denied any pain, hematochezia, fevers or chills. In the ED he underwent a CT scan which showed a well circumscribed air-containing elongated and conelike region occupying the rectum and rectosigmoid with mild thickening of the rectal wall without extraluminal air. We initially gave him 4L of Golytely to flush the object, but he did not pass the object on his own. During flexible sigmoidoscopy we could appreciate a very strictured and erythematous rectum and a smooth, white, plastic object lodged in the rectosigmoid colon. Multiple attempts at pulling the object out with rat-tooth forceps, snare, and Roth net were all futile as we could not pull the object through the narrowed rectum. We then inserted a heavily lubricated esophageal overtube through the rectum and pulled the object into the overtube and removed the cap and overtube together. The overtube helped dilate and straighten the rectum while allowinging the object to be secured into the overtube. DISCUSSION: The incidence of patients presenting to emergency departments with rectal foreign bodies is increasing, particularly in males. Recurrent episodes of rectal foreign body insertion requiring repeat endoscopic and surgical interventions for extraction can lead to anorectal stricturing. The alteration of anatomy may, as in this case, result in difficulty with foreign body extraction despite endoscopic access to the object. Stenting of the overlying mucosa and straightening of the rectum with overtube placement may facilitate successful retrieval of the rectal foreign body.

1978 Picking up the Pieces: Surgical and Medical Management of Retained Shattered Glass in the Rectum

INTRODUCTION: Retained rectal foreign bodies are an increasingly common presentation requiring emergent surgery. The object can often be retrieved at bedside. However, in the setting of a retained foreign body, especially one complicated by bleeding, perforation, or peritonitis, open surgery or laparoscopic assisted transanal retrieval is often needed. Careful investigation and a high index of suspicion is required as patients are often reluctant to share the etiology of their presentations. CASE DESCRIPTION/METHODS: A 55-year-old male presented to the ED with complaints of rectal bleeding. He stated he had placed a glass bottle in his rectum. Upon removal he noticed the top half of the bottle was retained inside his rectum. He developed mild rectal pain and bright red blood per rectum. On exam, there were no peritoneal signs. DRE revealed no perianal lesions, sphincter lacerations, or palpable foreign bodies. Initial labs displayed hemoglobin and hematocrit at 11.7 and 34.1, respectively. CT showed multiple radiopaque foreign bodies in the distal rectosigmoid measuring up to 14 cm in length with presacral edema. Proctoscopy was performed in the OR. Glass which was readily removable via a transanal approach was retrieved, while larger perforating pieces were carefully mobilized proximally and retracted via laparotomy. Sigmoidoscopy confirmed complete removal with multiple deep lacerations and perforations in the rectal wall. On post-op day seven, large volume rectal and mucus fistula bleeding with severe hypotension, tachycardia, change in mental status and a drop in hemoglobin to 5.8 occured. MTP was activated with administration of a total of five units of PRBC and two units of FFP. Colonoscopy was performed in the OR. An ulcer containing a pulsating, protruding, visible vessel was actively bleeding. Two clips were placed over the vessel with no further episodes of bleeding. Three months postoperatively barium enema was performed showing no leaks leading to reversal of colostomy. DISCUSSION: A retained rectal foreign body is not commonly the cause of a surgical emergency. Post-op complications, such as rectal bleeding, are rare and are normally handled by a return to the OR to control the source. Colonoscopy after a perforating rectal injury may be considered to evaluate and stop the source of postoperative bleeding, thus avoiding additional surgery and decreasing recovery time. Additionally, DRE should be cautioned when suspecting sharp hazardous material at an undetermined height in the colorectal tract.

Foreign Body Rectum- A Case Report

Rectal foreign bodies are confronted frequently in a surgical emergency. These are often related to sexual behaviour. Due to the fear of social embarrassment, patients tend to hide the facts associated with the incident and present late. Because of the serious complications, foreign body rectum should be considered as an emergency and managed in a well-organised manner. Diagnosis can be made by clinical and radiological examination. In the majority of cases, the transanal approach is successful. Laparotomy is reserved for cases with perforation or peritonitis. Here, we report the case of a 24-year-old male who inserted an electrical beard trimmer in his rectum under alcohol intoxication. Since transanal removal failed, emergency laparotomy with successful removal of foreign body was done.

Unusual presentation of a rectal foreign body: a diagnostic dilemma

Rectal foreign bodies present a challenge to surgeons from obtaining the correct diagnosis to managing the patient due to a wide array of presentation. Diagnostic dilemmas often arise as patients are sometimes unwilling to disclose the actual history and seek medical attention late. We present a case of a 65 year old Asian gentleman who present with history of per-rectal bleeding, tenesmus, acute urinary retention, constitutional symptoms with investigations suggestive of rectal malignancy. Intraoperatively identified a rubber-like foreign body tightly packed in the pelvic-cavity with severe injury to the rectum requiring abdominal-perineal resection.

Vacuum-assisted foetal delivery device to remove a rectal foreign body – A novel application of the Ventouse method

Rectal foreign bodies (RFBs) are an unusual emergency presentation readily confirmed via clinical examination and imaging, which must be quickly removed due to the risk of rectal wall tissue damage leading to perforation and subsequent peritonitis.

Austere Foreign Body Injuries in Children and Adolescents: A Characterization of Penile, Rectal, and Vaginal Injuries Presenting to Emergency Departments in the United States From 2008 to 2017.

Pediatric foreign body (FB) injuries to the nasal, aural, and/or oral cavities are well documented. Description of austere foreign body (AFB) injuries involving the rectum, vagina, or penis eludes the current pediatric literature. Austere FBs can be difficult to identify and have the potential to cause serious consequences. We aim to characterize AFB injuries by children and adolescents presenting to emergency departments (EDs) in the United States. The National Electronic Injury Surveillance System was queried to include subjects aged 0 to 25 years using a primary search term for diagnosis of foreign body from the period of January 2008 to January 2017. The consumer product and the body part involved (ie, rectal, vaginal, penile) were analyzed. Taylor series linearization generated national estimates. A trend analysis was performed using the Cochrane Armitage test of trend. There were 27,755 (95% confidence interval, 21,170-34,338) national estimated childhood ED visits for suspected AFB injuries during 2008 to 2017 including an estimated 7756 vaginal FBs, 7138 penile FBs, and 8359 rectal FBs (RFBs). Over the timeline, there was a significant up trend in the frequency of annual RFBs (P < 0.01). Austere FB injuries appear to cluster around age of 7 years. Most AFB injuries are able to be treated and released from the ED. It appears that RFB injury frequencies are rising and tend to require more frequent admission. Providers must be vigilant in the diagnosis and management of these potentially hazardous injury types.

Retained rectal foreign body in a child operated for high anorectal malformation

Foreign body ingestion is not uncommon in pediatric age group. Foreign bodies including coin retention/impaction at the colorectal regions are less frequently reported in children and extremely rare in the operated cases of anorectal malformation (ARM). The present case is a 5.8-year-old boy who had retention of ingested foreign body (coin) in his rectum for 4 months. His history revealed that he was a case of high ARM which was managed with three-staged procedures. His clinical examination and radiological investigations revealed an anal stricture and a foreign body (coin) in his rectum. He was managed well with anal dilatation and removal of coin under general anesthesia. The intention for presenting the case is its rarity.

Broken Glass: The Precarious Rectal Foreign Body

Despite the increasing frequency of presentations for retained rectal foreign body, it remains a topic of intrigue, likely in part due to the taboo nature of the dilemma and also the ingenuity that is often required for successful extraction. Although the true incidence of retained rectal foreign body is unknown, there is data to suggest that the incidence is on the rise.

Management of rectal foreign body with endoscopic snare: a case report

Foreign bodies in the rectum, although not much common present a challenging task to the surgeons for retrieval. Depending on the type and position they can cause anorectal trauma and perforative peritonitis. Diagnosis is usually by history, per rectal examination and radiography. Here authors present a 27-year-old male who came with history of insertion of candle into rectum to prevent bleeding from haemorrhoids. Perforative peritonitis was ruled out and manually tried to remove it and all attempts failed. He was posted for colonoscopy and it revealed 23cm long candle in the rectum with bleeding anal tag. The tip of candle extended into sigmoid colon. Polypectomy snare applied around the candle and foreign body was gently removed. Check colonoscopy revealed no significant injury. He was referred to psychiatry department and he was discharged the next day.

Rectal Foreign Body in a 30 Year Old Male- A Case Report

Though anorectal foreign body cases are rare, they have become increasingly frequent in recent years. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. The diagnosis may be made by rectal examination and metallic objects can be confirmed by plain abdominal radiographs. Transanal removal is only possible for very low-lying objects, while patients with high-lying foreign bodies usually require an operative intervention. An early decision of laparotomy should only be made after subjecting the patient to suitable investigations to determine exact location of the object, in order to avoid any inadvertent damage to the adjoining vasculature as well as anal incontinence. . We report the case of a young male who presented at surgery department of Shaheed Suhrawardy medical college hospital with severe rectal pain due to insertion of an apple into rectum by some eunuchs. It was successfully removed transanally under spinal anesthesia. Post operative period was uneventful and referred for psychiatric consultation.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 35-37

A RARE CASE OF PRESENCE OF UNUSUAL FOREIGN BODY IN RECTUM IN HOMOSEXUAL MALE

Foreign body in the rectum is rare yet potentially life-threatening condition; fear of social embarrassment causes the patient to delayto seek treatment and even hide the actual history and replace imaging reports, which leads to incorrect diagnosis and eventually thetreatment. In this article, we report the case of a 30 years hepatitis B positive, homosexual male who presented to the departmentwith a chief complaint of pain in the lower abdomen and was diagnosed to have foreign body (pestle) in rectum, which was insertedas a part of sexual adventure and deliberate attempt was made by the patient to replace X-ray films with other patients to misleadthe treating doctor. Finally, the foreign body was removed surgically and was followed by psychiatric evaluation of the patient.

Rectal Foreign Body for to Self-Inflicted Anal Eroticism in Man: Clinical Case

Background: Historically, the acceptance of anorectal sexual practices has varied throughout different civilizations. While he was condemned in biblical times, anal intercourse was often practiced by the Greek and Roman civilizations. Due to the current changes in sexual behavior, the surgeon is currently facing new problems in the diagnosis and treatment of rare rectal lesions. Clinical case: Male 37 years-old, married who presents to the emergency room complaining of pain in posterior anorectal area to the introduction of a foreign body, the patient reports attempted manual removal at home by maneuvers Valsalva unsuccessfully. Patient with stable vital signs and physical examination, normal chest and abdomen and rectal exam glass object is palpated proximal end with metal, plain abdominal radiography is requested where is evident the intraanal object. Laboratory test normal: Manual removal is attempted in emergencies without success due to the caused pain and decided to pass to the operating room where under spinal block and position in Sevillian razor a curve clamp rings is used and removal of the foreign body is achieved without difficulty. Discussion: Retained rectal foreign body is not an uncommon condition, but reliable epidemiological data are not available. The aim of the clinical evaluation is to identify the type, number, size, shape and location of the foreign body. Removal of retained rectal foreign bodies requires experience, with particular attention to different methods of extracting various objects. It is mandatory to perform a proctosigmoidoscopy after anorectal foreign body removal to exclude bowel injury and ensure that the patient has not inserted more than one foreign body. Patients with mucosal abrasion, tears and edema are to be admitted for a period of observation

Procedural Sedation for the removal of a rectal foreign body

Procedural Sedation for the removal of a rectal foreign body

A rare case of rectal perforation from an accidentally swallowed foreign body.

Key Clinical MessageRectal foreign bodies are not an infrequent presentation and can cause a serious dilemma regarding extraction and management. Management is determined by the site of the injury, degree of fecal contamination, the hemodynamic status of the patient, and comorbidities. Intraperitoneal injuries require surgery in the form of either a primary repair or formal resection with or without diversion. Extraperitoneal perforations maybe managed with presacral drainage and antibiotics with or without diversion.