A retrospective analysis of transanal surgical management of 291 cases with rectal foreign bodies

A case of a stuck mesh in the rectum after pelvic surgery

A 67-year-old woman was referred to our hospital for further evaluation of a positive fecal occult blood test. Colonoscopy revealed an elevated rectal lesion (10 mm in size) with a central depression. A rod-like object was noted in the center of the lesion. Magnifying endoscopy with narrow-band imaging showed obscure surface structures and dilated vessels. Magnifying endoscopy with crystal violet staining showed that the pit pattern had disappeared. These endoscopic findings suggested that the lesion was comprised of granulation tissue. A detailed medical history revealed that she had undergone a total hysterectomy with mesh placement for bladder prolapse. We reasoned that the mesh used during pelvic surgery might have penetrated the rectum. She underwent subsequent surgery to remove the mesh. Although most foreign bodies in the rectum are swallowed or self-inserted, pelvic surgery is another source of foreign bodies in the rectum.

Endoscopic treatment for a huge self-inserted foreign body impacted in colon

A 37-year-old male suffered from abdominal pain and distention for 8 hours after a huge long foreign body was inserted through anorectum by self-masturbation. The colonoscope with the polypectomy snare griped the foreign body was pulled out slowly along with the dragged foreign body. However, when we reached at 20 cm from the anal margin, it got stuck because of the turn point in the sigmoid colon. Different methods were tried to remove the foreign body. At last, We asked the patient to turn to supine position, take deep breath and defecation. More air was insufflated to make the colon cavity larger to facilitate removal, and slowly the colonoscope dragged the foreign body (35 cm in length) out from the anus successfully. No bleeding or perforation occurred during the procedure. Although the foreign body was huge, effort was made to help the patient avoid taking operation.

Anorectal Emergencies

Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.