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Zhou PF, Lu JG, Zhang JD, Wang JW. Colonoscopy-assisted removal of an impaction foreign body at the rectosigmoid junction: A case report. World J Clin Cases 2024; 12:1990-1995. [PMID: 38660553 PMCID: PMC11036519 DOI: 10.12998/wjcc.v12.i11.1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/07/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND When an anorectal foreign body is found, its composition and shape should be evaluated, and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body. CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3, 2023, due to a rectal foreign body that had been embedded for more than 24 h. The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids, however, the electrode tube was inadvertently inserted into the anus and could not be removed by the patient. During hospitalization, the patient underwent surgery, and the foreign body was dragged into the rectum with the aid of colonoscopy. The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body, and the local anal symptoms were then relieved with topical drugs. The patient was allowed to eat and drink, and an entire abdominal Computed tomography (CT) and colonoscopy were reviewed 3 d after surgery. CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum, and no apparent intestinal tract damage. CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases. The type, material and the potential risks of rectal foreign bodies should be considered.
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Affiliation(s)
- Peng-Fei Zhou
- Department of Anorectal Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Jin-Gen Lu
- Department of Anorectal Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Jia-Dong Zhang
- Department of Anorectal Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Jia-Wen Wang
- Department of Anorectal Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
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2
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Eizuka M, Toya Y, Akasaka R, Yamada S, Oizumi T, Kasugai S, Yanai S, Sugimura Y, Matsumoto T. A case of a stuck mesh in the rectum after pelvic surgery. DEN OPEN 2024; 4:e286. [PMID: 37720193 PMCID: PMC10502397 DOI: 10.1002/deo2.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
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.
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Affiliation(s)
- Makoto Eizuka
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Yosuke Toya
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Risaburo Akasaka
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Shun Yamada
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Tomofumi Oizumi
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Satoshi Kasugai
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Shunichi Yanai
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | | | - Takayuki Matsumoto
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
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3
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Frendt E, Masroor M, Saied A, Neeki A, Youssoffi S, Malkoc A, Dong F, Tran L, Borger R, Wong DT, Neeki M. Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis. Cureus 2023; 15:e49413. [PMID: 38149151 PMCID: PMC10750084 DOI: 10.7759/cureus.49413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.
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Affiliation(s)
- Eric Frendt
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Momin Masroor
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arman Saied
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arianna Neeki
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Santana Youssoffi
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Aldin Malkoc
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Fanglong Dong
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Louis Tran
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Rodney Borger
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - David T Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Michael Neeki
- Emergency Department, California University of Science and Medicine, Colton, USA
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
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4
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Gupta RK, Kumar A, Khanal B, Suraj KC, Lamichhane S. Cough syrup bottle at rectum in elderly male: a rare case report. J Surg Case Rep 2023; 2023:rjad404. [PMID: 37434718 PMCID: PMC10331801 DOI: 10.1093/jscr/rjad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
Foreign body in the anal canal may be inserted for sexual gratification or sexual assault or accidental or drug trafficking. We report a case of a male who accidentally inserted a cough syrup bottle in his rectum. Presentation is usually late due to fear and embarrassment. The manual attempt of removal may be tried under adequate anesthesia. Post-procedure sigmoidoscopy or colonoscopy may be helpful to diagnose laceration or mucosal injury.
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Affiliation(s)
- Rakesh K Gupta
- Department of General Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhijeet Kumar
- Department of General Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bhawani Khanal
- Department of General Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - K C Suraj
- Correspondence address. Department of General surgery, BP Koirala Institute of Health Sciences, Buddha Road, Dharan 56700, Nepal. Tel: +9779841622404; E-mail:
| | - Samiksha Lamichhane
- Department of Radiodiagnosis and Imaging, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Sheets NW, Waldrop I, Carpenter WC, Dubina E, Kondal B, Schultz H, Plurad D. Rectal Foreign Bodies: A 10-Year Review of the National Electronic Injury Surveillance System. Cureus 2023; 15:e41471. [PMID: 37546136 PMCID: PMC10404145 DOI: 10.7759/cureus.41471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Rectal foreign bodies may result in significant morbidity, potentially necessitating surgical intervention and ostomy creation. The sensitive nature of the diagnosis may lead to inaccurate patient history and possible delay in diagnosis. Currently, there is a paucity of large national studies addressing this diagnosis. Therefore, we present national data describing the demographics and incidence of patients presenting with rectal foreign bodies. Methods The National Electronic Injury Surveillance System (NEISS) was utilized to collect data regarding rectal foreign bodies. Ten years of data were collected from 2012 to 2021. Inclusion criteria focused on the diagnosis of "foreign body" coupled with pelvic and lower torso injuries. Exclusion criteria encompassed patients without a rectal foreign body clearly identified in the narrative. Patients were compared based on disposition as low severity (treated/examined and released or left without being seen) or high severity (treated and admitted/hospitalized, held for observation, or transferred to another facility). General descriptive and inferential analyses were performed regarding demographics and dispositions. Results A total of 1,806 emergency department (ED) visits were identified for inclusion. Patients ranged in age from 0 to 93 years, with a mean age of 30 years. The largest age group identified was 11-15 and 21-25 years. Most patients were male (64.6%) and white (47.1%). The most common foreign bodies were massage devices and vibrators (22.7%), jewelry (8.1%), pens and pencils (4.4%), fishing gears (activity, apparel, or equipment) (3.7%), and nonglass bottles or jars (2.6%). Patients requiring admission, observation, or transfer differed from those patients that were discharged from the ED by age, sex, race, and product involved. Discussion Rectal foreign bodies are a rare diagnosis with a growing incidence. Though the most common objects are massage devices and vibrators consistent with sexual stimulation devices, there are limited product guidelines for safe use. Further studies to help identify at-risk persons, safety precautions, and manufacturing guidelines may help prevent potential morbidity associated with rectal foreign bodies.
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Affiliation(s)
- Nicholas W Sheets
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - Ian Waldrop
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | | | - Emily Dubina
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - Bhani Kondal
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - Hayden Schultz
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
| | - David Plurad
- Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA
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Loria A, Marianetti I, Cook CA, Melucci AD, Ghaffar A, Juviler P, Temple LK, Jones CMC, Fleming FJ. Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021. Am J Emerg Med 2023; 69:76-82. [PMID: 37060632 DOI: 10.1016/j.ajem.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Presentations to the emergency department for rectal foreign bodies are common, but there is little epidemiologic information on this condition. This limits the ability to provide evidence-based education to trainees regarding the populations affected, the types and frequency of foreign bodies, and factors associated with hospitalization. To address this, we analyzed national estimates of emergency department presentations for rectal foreign bodies from 2012 to 2021 in the US. METHODS We queried the National Electronic Injury Surveillance System for any injury to the 'pubic region' or 'lower trunk' with an accompanying diagnosis of foreign body, puncture, or laceration. Two authors manually reviewed all clinical narratives to identify cases of rectal foreign bodies. National estimates were determined using weighting and strata variables, incidence rates calculated using census data, trends assessed by linear regression, and factors associated with hospitalization identified by multivariable logistic regression. RESULTS From 885 cases, there were an estimated 38,948 (95% CI, 32,040-45,856) emergency department visits for rectal foreign bodies among individuals ≥15 years from 2012 to 2021. The average age was 43, 77.8% were male, 55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization. The annual incidence of presentations for rectal foreign bodies increased from 1.2 in 2012 to 1.9 per 100,000 persons in 2021 (R2 = 0.84, p < 0.01). Males have a bimodal age distribution peaking in the fifth decade, while females have a right-skewed age distribution peaking in the second decade. Female sex (odds ratio [OR] 0.4; 95% confidence interval [CI], 0.2-0.6) and, compared to sexual devices, balls/marbles (OR 0.2; 95% CI, 0.05-0.6) or drugs/paraphernalia (OR 0.1; 95% CI, 0.05-0.4) are associated with a reduced odds of hospitalization. CONCLUSIONS Presentations to the emergency department for rectal foreign bodies increased for males and females from 2012 to 2021 in the United States. These epidemiologic estimates for a complex form of anorectal trauma provide preclinical information for emergency medicine, surgery, and radiology trainees.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ila Marianetti
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Caitlin A Cook
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Aqsa Ghaffar
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Juviler
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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7
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Pinto MYP, Wee C, Jarmin M. Management of rectal foreign body: a rare complication with colonic intussusception. ANZ J Surg 2023; 93:766-767. [PMID: 36039814 DOI: 10.1111/ans.18008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Cecilia Wee
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Martin Jarmin
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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8
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Nepal A, Maharjan S, Chalise A, Rajbhandari AP. Rectal Foreign Body: A Case Report. JNMA J Nepal Med Assoc 2022; 60:1049-1051. [PMID: 36705106 PMCID: PMC9795131 DOI: 10.31729/jnma.7905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Indexed: 12/03/2022] Open
Abstract
The rectal foreign body is a rare presentation, often related to sexual gratification, sexual assault, or the result of ingestion and rarely accidental, and with rising incidence. We present a case of a 47-year-old heterosexual male with an alleged history of accidental insertion of a foreign body through the anus three days prior without peritonitis or obstipation. After investigations, the patient underwent a failed sigmoidoscopic removal followed by exploratory laparotomy, foreign body removal, and an uneventful post-operative period. It should be noted that early diagnosis and timely intervention are important to prevent complications in rectal foreign bodies. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of failed manual extraction techniques and complicated cases. Keywords case reports; foreign bodies; laparotomy; rectum; sigmoidoscopy.
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Affiliation(s)
- Anamika Nepal
- Shankarapur Hospital Pvt. Ltd, Gokarneshwor, Kathmandu, Nepal
| | - Shailesh Maharjan
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Anup Chalise
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal,Correspondence: Dr Anup Chalise, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal. , Phone: +977-9849516920
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9
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Zhang Y, Han Y, Xu H, Chen D, Gao H, Yuan H, Zeng X. A retrospective analysis of transanal surgical management of 291 cases with rectal foreign bodies. Int J Colorectal Dis 2022; 37:2167-2172. [PMID: 36057731 DOI: 10.1007/s00384-022-04230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rectal foreign bodies (RFB) are quite uncommon except in very busy hospitals. Because of their rarity, it is seldom that the treating physicians have a standard approach to the diagnosis, technique of extraction, and post-extraction evaluation. This can be further complicated by the rather extreme variability of size, shape, and texture of the foreign bodies, as well as the potential extent of trauma to the rectum or distal colon. AIM The objectives of this study were to delineate the demographics, classification of cause, and injury patterns of RFB and to present the results of the transanal surgical management of a large series of RFB. METHODS We retrospectively collected extensive data from the hospital medical records of the 291 patients who presented with RFB to the emergency department of Shenyang Proctological Hospital (Shenyang, China) from 2012 July to 2020 December. Specifically, demographics, origins and circumstance of the RFB, complications, injuries, anesthesia method, and the results of the transanal surgical management were recorded and analyzed. RESULTS Of the 291 RFB cases, 225 (77.3%) were male and 66 (22.7%) were female, with a mean age of 53.8 ± 15.5 years (range, 1 ~ 88 years). The circumstances of the RFB were categorized as swallowed, 199 cases (68.4%); self-inserted, 87 (29.9%); and iatrogenic, 5 (1.7%). The proportion of males in the self-inserted RFB group was significantly greater than the swallowed RFB group (t = 31.114, p = 0.000). In the swallowed RFB group, the most common anorectal injuries and pathological changes were the following: penetration into the mucosa (75 cases, 37.7%), perianal or submucosal abscess (27 cases, 13.6%), and penetration into the anal canal (18 cases, 9.0%). In the self-inserted RFB group, 64 (73.6%) of the 87 cases had an intact rectum, whereas 8 (9.2%) had rectal mucosal ulcers and bleeding, and 7 (8%) had rectal lacerations. In the iatrogenic RFB group, 3 cases (60%) had rectal mucosal ulcers and bleeding, and 2 cases (40%) had inflammation of the rectal mucosa. Regarding extraction procedures, in the swallowed group, 187(187/199; 94%) patients underwent a transanal surgical procedure, and all were successful. In the self-inserted group, 82 patients underwent the transanal surgical procedure, and 74 (74/82; 90.2%) were successful whereas it was unsuccessful in the remaining 8 patients (8/82, 9.8%). Three (3/4, 75%) patients with iatrogenic RFB were resolved by the transanal surgical procedure. CONCLUSION Men were markedly more likely than women to have swallowed RFBs and self-inserted RFBs. No serious damage to the rectum and anus was found in cases of swallowed RFB. Moreover, most surgical operations to remove foreign bodies via the anus were successful in this category of RFB. In contrast, rectal injury was more severe in patients with self-inserted RFB, such as rectal laceration, rectal mucosal ulcer, and bleeding. Moreover, the transanal removal operation in patients with self-inserted RFB had a failure rate of nearly 10%. Thick, long, hard foreign bodies did present a great challenge to the operator. Therefore, if necessary, patients with foreign bodies may need to be promptly referred for transabdominal removal.
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Affiliation(s)
- Yong Zhang
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, 9th of North Nanjing Street, Heping District, Shenyang, 110002, China.
| | - Yi Han
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, 9th of North Nanjing Street, Heping District, Shenyang, 110002, China
| | - Huimian Xu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155th of North Nanjing Street, Heping District, Shenyang, 110001, China
| | - Deyu Chen
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, 9th of North Nanjing Street, Heping District, Shenyang, 110002, China
| | - Hongjian Gao
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, 9th of North Nanjing Street, Heping District, Shenyang, 110002, China
| | - Hexue Yuan
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, 9th of North Nanjing Street, Heping District, Shenyang, 110002, China
| | - Xiandong Zeng
- Health Commission of Shenyang, 13th of Beiqi Street, Heping District, Shenyang, 110003, China
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10
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Management of unusual rectal foreign body - Case report and literature review. Int J Surg Case Rep 2022; 94:107051. [PMID: 35452941 PMCID: PMC9048151 DOI: 10.1016/j.ijscr.2022.107051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Retained rectal objects represent a rare complaint in the emergency room, affecting mainly males between 20 and 40 years, with most objects of a sexual nature, but the examiner must be aware of objects of an unusual nature. Presentation of case A 54-year-old male patient arrives at the surgical emergency department, with a report of an accident with the insertion of an object via the rectum, a gym dumbbell. Initially opted for transrectal object removal, but with difficulties due to its position. Discussion Retained rectal objects are a rare complaint in the emergency department, but with an increasingly important occurrence in recent years. Physical examination should include an assessment of the abdomen and digital rectal examination. Imaging tests are mandatory for diagnosis, with abdominal and pelvis radiography being the most requested. Although there is no consensus on the most appropriate removal technique, less invasive initial approaches are recommended, with transanal removal with a 60–75% success rate under local anesthesia. The follow-up after the procedure depends on several factors, and in general, the patient should be kept under observation and attention should be paid to significant changes in the evolution and alterations in the imaging tests. Conclusion The clinical history in these cases can be confusing, due to the patient's fear of reporting the complaints. Radiography is the best initial test, and CT is reserved for cases of suspected complications. Whenever possible, perform the extraction rectally. Retained rectal objects are a rare complaint in the emergency department. Less invasive initial approaches are recommended. The follow-up after the procedure depends on several factors.
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11
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Yang Z, Xin P, Zhou S, Zhou C, He X, Bao G. Systematic review of rectal foreign bodies in older men: humanistic care and a novel challenge for society. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:164. [PMID: 35280427 PMCID: PMC8908176 DOI: 10.21037/atm-22-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Background In recent years, rectal foreign bodies have become a common proctological emergency in the male population, especially older Chinese men, often requiring surgical intervention due to associated complications. This review aimed to describe the epidemiology and clinical characteristics of rectal foreign bodies in older men and examine the possible challenges presented by the condition to clinicians and society. Methods A comprehensive search was conducted in English-language databases and Chinese databases from January 2000 to December 2020. Studies concerning rectal foreign bodies were considered for this review if they reported the reason for a foreign body being in the rectum and related treatment measures. Contemporaneous rectal foreign bodies case data from General Surgery Department of Tangdu Hospital were also analyzed. According to differences in ethnicity, the older male patients were divided into a Chinese group and a non-Chinese group, and the parameters of the two groups were analyzed using statistical methods. Results A total of 159 studies were retrieved in an initial database search using “rectal foreign body” as the search term. These included 86 Chinese studies and 73 English-language studies. Collectively, these studies included 582 older male patients, 276 of whom were Chinese, and 307 who were non-Chinese. According to their source, the rectal foreign bodies were classified into 3 categories. The most common reason for a foreign body in the rectum was insertion for erotic purposes, with everyday articles accounting for most foreign body types. Sexual articles were mainly found to have been used in the pursuit of pleasure. There were no significant differences in foreign body sources, sizes, types, treatment selections, and outcomes between the two groups. Discussion Emergency hospital visits by older men with rectal foreign bodies due to erotic and sexual needs and practices are increasing. Although the sources, sizes, and types of foreign bodies were different, and patients recovered well after active and appropriate clinical treatment, the sexual needs of older men are a social issue that requires attention. Acknowledging and dealing with sexual issues is a multidimensional task that requires a collaborative effort to ensure a more humanistic approach to older patients.
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Affiliation(s)
- Zhenyu Yang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Peiyuan Xin
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Shuai Zhou
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chuxin Zhou
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xianli He
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Guoqiang Bao
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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12
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Paduano D, Auriemma F, Bianchetti M, Repici A, Mangiavillano B. Bike handlebar grip in the rectum: minimally invasive endoscopic management. Endoscopy 2022; 54:E42-E43. [PMID: 33682900 DOI: 10.1055/a-1362-9026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Mario Bianchetti
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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13
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Management of Asymptomatic Perforation of a Pediatric Rectal Foreign Body into the Peritoneal Cavity Retrieved with Laparoscopy: A Case Report and Review of the Literature. Case Rep Med 2021; 2021:5851967. [PMID: 34876906 PMCID: PMC8645393 DOI: 10.1155/2021/5851967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Rectal foreign body insertion has had an increasing trend throughout the years, whereas it is rarely reported in pediatrics. The management and treatment of these cases can become challenging, since it also can present with atypical or even no symptoms in physical evaluation. A 14-year-old boy was referred to our hospital with a history of insertion of a paintbrush into his anus four weeks before the admission. The paintbrush had perforated the colon and was in the abdominopelvic cavity; however, no symptoms of peritonitis were observed. Rectal examination, sigmoidoscopy, and colonoscopy were unremarkable. Exploratory laparoscopy was performed, and the paintbrush was taken out completely. The patient was discharged in good condition. In cases with rectal foreign body insertion, perforation without causing peritonitis or acute abdomen is possible. In these conditions, imaging examinations play an essential role in managing the patients, and laparoscopy can be a proper procedure for retrieving the foreign body.
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14
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Lefcourt T, Ku A, Issagholian L, Neeki AS, Retamozo M, Dong F, Neeki MM. Novel Bedside Utilization of Foley Catheter in the Emergent Removal of Colorectal Foreign Body: A Case Report and Literature Review. Cureus 2021; 13:e20217. [PMID: 35004037 PMCID: PMC8729319 DOI: 10.7759/cureus.20217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Rectal foreign bodies (RFBs) present unique challenges to the emergency physician. Failure to emergently remove the RFB may lead to additional intraoperative procedures with increased likelihood of complications. We present a case of retained RFB in the emergency department, in which the usual standard approaches to transanal removal had failed. A last-ditch effort by utilizing a Foley catheter inside the object rather than around it led to the successful removal of the RFB. An intense review of the literature highlights the importance of using various novel applications of a Foley catheter to consider cases of RFBs.
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15
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Fischer J, Krishnamurthy J, Hansen S, Reeves PT. 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. Pediatr Emerg Care 2021; 37:e805-e811. [PMID: 30870345 DOI: 10.1097/pec.0000000000001803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Julie Fischer
- From the Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
| | - Jayasree Krishnamurthy
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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16
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Mantha P, Ng JYS, Elsabagh A, Slack T. Novel technique for retrieval of rectal foreign body using suprapubic catheter. ANZ J Surg 2021; 92:1889-1890. [PMID: 34752674 DOI: 10.1111/ans.17358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pranay Mantha
- Colorectal Surgery Department, The Princess Alexandra Hospital, Wooloongabba, Queensland, Australia.,Faculty of Health, School of Medicine, The Griffith University, Wurtulla, Queensland, Australia
| | - Jessica Yan-Seen Ng
- Colorectal Surgery Department, The Princess Alexandra Hospital, Wooloongabba, Queensland, Australia.,Faculty of Health, School of Medicine, The Griffith University, Wurtulla, Queensland, Australia
| | - Abdallah Elsabagh
- Colorectal Surgery Department, The Princess Alexandra Hospital, Wooloongabba, Queensland, Australia
| | - Timothy Slack
- Colorectal Surgery Department, The Princess Alexandra Hospital, Wooloongabba, Queensland, Australia.,Colorectal Surgery Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
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17
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Saeed Bamashmos A, Heshmetzadeh Behzadi A, Elfatairy K, Megahed A, Kochar P, Hegde R. Foreign bodies of body orifices: A pictorial review. Clin Imaging 2021; 80:180-189. [PMID: 34333353 DOI: 10.1016/j.clinimag.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ingestion, inhalation, and insertion of foreign bodies (FB) are commonly encountered problems in the emergency departments (ED). Radiologists pay a key role in their diagnosis and management. Selecting an appropriate imaging modality is important depending on the route of entry and reported type of FB. Diagnosing FB is time sensitive and requires radiologists to be astute and familiar with varied imaging appearances of FB. In this article, we review imaging features of most common FB seen in clinical practice and their complications. TEACHING POINTS SUMMARY: FB in body orifices are frequently seen in the ED. Imaging plays a pivotal role in the management in majority of the cases. In this article, we present several cases of commonly encountered FB.
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Affiliation(s)
- Anas Saeed Bamashmos
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States.
| | | | - Kareem Elfatairy
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
| | - Ayah Megahed
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
| | - Puneet Kochar
- Penn State Hershey Milton S Hershey Medical Center, Hershey, PA, United States
| | - Rahul Hegde
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
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18
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Gan DEY, Chan KH, Veerappan P, Sun KJ, Hayati F. Rectal Foreign Body: A Successful Removal at the Bedside and Detailing of a Stepwise Management. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930967. [PMID: 34135299 PMCID: PMC8218603 DOI: 10.12659/ajcr.930967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A rectal foreign body (RFB) can be stigmatizing for patients and present a dilemma for the treating physician. Removal can be challenging owing to the variety of objects introduced. The goals of therapy are to safely remove the RFB and to minimize injury to the bowel. CASE REPORT A 22-year-old man was referred from a district hospital to our institution after being unable to remove a self-inflicted RFB after sexual gratification. He was hemodynamically stable with a soft and nontender abdomen. A mass was felt in the suprapubic region. Abdominal radiography revealed a well-defined radiolucent object in the pelvic region, which was consistent with a lubricant bottle. No sign of bowel obstruction or perforation was observed. The RFB was successfully retrieved by a combination of transrectal digital manipulation and directed gentle abdominal pressure, allowing for descent of the RFB and transanal traction at the bedside. Various approaches have been described for removal of a RFB, from simple bedside strategies to open surgery for complicated cases. Endoscopy and minimally invasive techniques have also demonstrated a role in formulating a tailored approach. CONCLUSIONS We describe a successful retrieval of an RFB at the bedside, avoiding unnecessary open surgery.
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Affiliation(s)
- David Eng Yeow Gan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
| | - Kheng Hooi Chan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.,Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur, Malaysia
| | - Pramanantha Veerappan
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Kian Joo Sun
- Department of Urology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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19
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Khan S, Khan S, Chalgari T, Akhtar R, Asad M, Kumar B. Case Series: Removal of Rectal Foreign Bodies. Cureus 2021; 13:e13234. [PMID: 33728183 PMCID: PMC7949707 DOI: 10.7759/cureus.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Foreign rectal body is one of the less common presentations in the emergency department and has a variety of etiologies. Our aim is to study the mode of injury, clinical presentation, diagnosis, surgical intervention and outcomes associated with a rectal foreign body. Methods: This cross-sectional case series was conducted from January 2019 to July 2019 in the surgical unit of a tertiary care teaching hospital in Pakistan. Mode of injury was classified as voluntary - for sexual gratification, involuntary ingestion, assault and fall. We also noted the presenting complaint, diagnosis, surgical intervention and outcome of the case. Results: Foreign body in the rectum was more common in men (86.3%) than women (13.7%). The mean age of participants was 40 ± 15 years. Various causes include sexual gratification (45.4%), involuntary ingestion (27.2%), assault (22.7%) and history of fall (4.5%). Participants were diagnosed with sub-acute intestinal obstruction (59%), peritonitis (22.7%) and perianal injury (36.3%). Conclusion: Sexual gratification was the most common reason for the retained rectum body. Timely diagnosis and management are required to prevent perforation and improve prognosis.
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Affiliation(s)
- Sharjeel Khan
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Sadia Khan
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Tariq Chalgari
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Riaz Akhtar
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Malak Asad
- General Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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20
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Abstract
PURPOSE Rectal foreign bodies can pose a unique problem to the acute care surgeon or emergency room physician. Little data exists on the patient with such a diagnosis, outside of case reports, and institutional cohorts. This study describes demographics and outcomes for this patient population. METHODS An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015 to 2018) was performed, capturing patients with a postoperative diagnosis of foreign body of the anus or rectum. Patients were stratified into two groups: those who underwent removal under anesthesia (EUA) and those who required surgical removal. Baseline demographics and outcomes were compared and described. RESULTS A total of 109 patients were included in the study. The average age was 49.29 ± 14.63 years. The majority of the population was male (92.66%) and white (78.90%). Demographics and preoperative variables were clinically similar between patients receiving an EUA or an operation. Length of stay was longer in patients receiving an operation (4.84 ± 3.27 versus 1.39 ± 3.20 days in those receiving an EUA, p < 0.0001). About 97.24% of the population discharged to their home residence. CONCLUSIONS This study describes a population of patients admitted for retained foreign body of the rectum, in a population larger than that can be described in a typical institutional review. EUA can be a safe approach to foreign body removal, with laparotomy carrying the typical risks of surgery. This population requires further study to identify the mechanisms and risk factors for alimentary tract injury to reduce operative interventions and improve outcomes.
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21
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Mulita F, Theofanis G, Tchabashvili L, Drakos N, Maroulis I. Rectal foreign bodies: retained orange. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:392-393. [PMID: 34976250 PMCID: PMC8690951 DOI: 10.5114/pg.2021.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Francesk Mulita
- Address for correspondence: Dr. Francesk Mulita, Department of Surgery, General University Hospital of Patras, Greece, e-mail:
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22
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Nesemann S, Hubbard KA, Siddiqui MI, Fernandez WG. Rectal Foreign Body Removal in the Emergency Department: A Case Report. Clin Pract Cases Emerg Med 2020; 4:450-453. [PMID: 32926710 PMCID: PMC7434246 DOI: 10.5811/cpcem.2020.7.47237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/03/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Rectal foreign bodies (RFB) pose a challenge to emergency physicians. Patients are not often forthcoming, which can lead to delays to intervention. Thus, RFBs require a heightened clinical suspicion. In the emergency department (ED), extraction may require creative methods to prevent need for surgical intervention. Case Report The authors present a case of a successful extraction of a RFB in the ED and review of the literature. Conclusion Retained RFBs are an unusually problematic reason for an ED visit. Thus, it is important for emergency physicians to be comfortable managing such cases appropriately.
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Affiliation(s)
- Samuel Nesemann
- University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
| | - Kimberly A Hubbard
- University of Texas Health San Antonio Long School of Medicine, Department of Emergency Medicine, San Antonio, Texas
| | - Mehdi I Siddiqui
- University of Texas Health San Antonio Long School of Medicine, Department of Emergency Medicine, San Antonio, Texas
| | - William G Fernandez
- University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
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23
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Bosi S, De'Angelis GL. Case report: successful endoscopic removal of a large rectal foreign body. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020074. [PMID: 32921770 PMCID: PMC7717012 DOI: 10.23750/abm.v91i3.7806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/22/2020] [Indexed: 11/23/2022]
Abstract
Incidence of emergency access due to retained large rectal foreign bodies is increased in the last years. Such situations are a challenge because often, due to their size and physical characteristics, the large foreign bodies of the rectum cannot be extracted manually or by endoscopy, thus requiring surgery, as reported in the literature. We report a case of a 59-old male with a retention of a large vegetable rectal foreign body (whole eggplant) successfully subjected to endoscopic removal without the need for surgery.
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24
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O'Laughlin M, Kim D, Lyman AL, Lesher AP. Pediatric rectal foreign body: Value of 3-D CT reconstruction. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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25
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Kim JH, Um E, Jung SM, Shin YC, Jung SW, Kim JI, Heo TG, Lee MS, Jun H, Choi PW. The Management of Retained Rectal Foreign Body. Ann Coloproctol 2020; 36:335-343. [PMID: 32054243 PMCID: PMC7714380 DOI: 10.3393/ac.2019.10.03.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience. Methods We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes. Results All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling. Conclusion Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.
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Affiliation(s)
- Ju Hun Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Myung Soo Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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26
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Popa F, Grigoroiu M, Georgescu ME. Intrarectal Foreign Body Detected at CT Scanner Investigating an Abdominal Syndrome. Case Rep Surg 2019; 2019:9134735. [PMID: 30881723 PMCID: PMC6387721 DOI: 10.1155/2019/9134735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
The field of general surgery offers many different pathologies, cases, and situations for which the general surgeons should be competent in diagnosis as well as treatment and management, including operative intervention. Most situations are complicated by delayed admission to the hospital due to the embarrassment of patient and inability to obtain satisfactory anamnesis. This article reviews the use of computed tomography as a problem-solving tool in the identification, localization, and presurgical planning for extracting the rectal foreign object.
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Affiliation(s)
- Florina Popa
- Department of General Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Madalina Grigoroiu
- Department of Morphological and Functional Sciences, “Dunarea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania
| | - Monica Elia Georgescu
- Department of Morphological and Functional Sciences, “Dunarea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania
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27
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Antegrade impalement of the rectum by a foreign body: a case report of a successful transanal extraction using the transanal single port (TAMIS) technique. Tech Coloproctol 2019; 23:175-178. [PMID: 30719574 DOI: 10.1007/s10151-019-1929-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
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28
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Shields HM, Scheid FJ, Pierce TT, Andersson KL, Conrad MF, Rosenthal MG, Martin SD. Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia. N Engl J Med 2019; 380:473-485. [PMID: 30699318 DOI: 10.1056/nejmcpc1810391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Helen M Shields
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Fabian J Scheid
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Theodore T Pierce
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Karin L Andersson
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Mark F Conrad
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Martin G Rosenthal
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
| | - Scott D Martin
- From the Department of Medicine, Brigham and Women's Hospital (H.M.S.), the Departments of Medicine (F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Massachusetts General Hospital, and the Departments of Medicine (H.M.S., F.J.S., K.L.A.), Radiology (T.T.P.), Surgery (M.F.C., M.G.R.), and Orthopedic Surgery (S.D.M.), Harvard Medical School - all in Boston
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29
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Robinson EC, Roy D, Driver BE. Deflate to Extricate: A Technique for Rectal Foreign Body Removal of Inflatable Ball. J Emerg Med 2017; 54:e23-e25. [PMID: 29239761 DOI: 10.1016/j.jemermed.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rectal foreign bodies are commonly encountered in the emergency department (ED). Three techniques are well described in literature, including using a Foley catheter, "scooping" the object out, or grasping the object directly with ring forceps. We present a novel extraction method for an inflatable foreign body. CASE REPORT A 27-year-old man presented to the ED 13 h after inserting a rubber inflatable child's ball into his rectum. After well-described extraction techniques failed to remove the ball, an 18-gauge needle at the end of a syringe was inserted into the rectum to puncture the ball and partially deflate it. The ball was then able to be removed easily. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although recent published literature has pushed for early consultation of surgical specialties in lieu of emergency physician bedside extraction, this case report highlights the ability of emergency physicians to modify known extraction techniques to safely remove rectal foreign bodies in well-appearing patients at the bedside using appropriate analgesia, positioning, and readily available equipment.
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Affiliation(s)
- Elizabeth C Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - David Roy
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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30
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Lazzari V, Siboni S, Asti E, Bonavina L. Transanal removal of a broken drinking glass self-inserted and retained in the rectum. BMJ Case Rep 2017; 2017:bcr-2017-220268. [PMID: 28576915 DOI: 10.1136/bcr-2017-220268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Retained rectal foreign bodies are increasingly reported in current clinical practice, and there is no clear consensus in the literature as to whether transanal extraction should be performed in the emergency or in the operating room. A 47-year-old presented to the hospital for a retained drinking glass in the rectum that was broken after an attempt at self-extraction. Physical examination showed no evidence of abdominal guarding nor bleeding from the rectum; abdominal and pelvic X-rays confirmed the presence of a broken glass, 8×6 cm in size and no signs of perforation. Initial anoscopy performed in the emergency room confirmed the partial fracture of the glass. The patient was transferred to the operating room and transanal extraction was carried out under general anaesthesia without complications.
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Affiliation(s)
| | - Stefano Siboni
- Universita degli Studi di Milano, Surgery, Milano, Italy.,IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy
| | - Emanuele Asti
- IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy.,Universita degli Studi di Milano, Biomedical Sciences for Health, Milano, Italy
| | - Luigi Bonavina
- Universita degli Studi di Milano, Biomedical Sciences for Health, Milano, Italy.,IRCCS Policlinico San Donato, Surgery, San Donato Milanese, Lombardia, Italy
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31
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Kokemohr P, Haeder L, Frömling FJ, Landwehr P, Jähne J. Surgical management of rectal foreign bodies: a 10-year single-center experience. Innov Surg Sci 2017; 2:89-95. [PMID: 31579741 PMCID: PMC6754005 DOI: 10.1515/iss-2017-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Patients with a rectal foreign body (RFB) are still a rare entity in general surgery departments but with an increasing incidence over the last years. This case is sometimes difficult to treat, and due to a lack of standardized treatment options, the aim of the study was to present our clinical experiences with the diagnostic and therapeutic approach to RFBs and a review of the currently available literature. Materials and methods Data were collected retrospectively from the patient’s records of 20 patients who were treated due to an RFB between 2006 and 2016. Patient’s demographics, circumstances of insertion, inserted objects, clinical presentation, laboratory and imaging results, as well as surgical treatment and duration of hospital stay were analyzed. Additionally, a review of the literature was performed with the search items “rectal foreign body” and “surgical therapy”. Because many publications were just case reports, we did not perform a meta-analysis or a systematic review. Results Twenty-two cases in 20 patients (80% male) presented to the emergency room. The mean age was 38.5±13.7 years. In 68.2% of the cases, the cause of RFB was due to sexual preferences. The following objects were inserted: six dildos, three vibrators, two bottles, one glass, one deodorant, one apple, one fever thermometer, multiple glass fragments and razor blades in one patient and six unknown objects. For 18 RFBs, manual peranal removal without anesthesia was possible in the emergency room, but two patients required intravenous analgesia. Two patients were transferred to the operating room and the foreign body was removed via the anus under general anesthesia. Open surgery with a laparotomy was necessary for two complicated cases. One patient was in need of surgery due to a vacuum generated by the RFB, whereas the second patient suffered from a sigmoid perforation. In all cases, there was no morbidity or mortality. Conclusion In most cases, the removal of an RFB can be performed peranally in the emergency room without further complications, therefore representing the therapy of choice for RFB. Only in cases with perforation, acute abdomen, or failed peranal approaches, surgery is indicated to remove the foreign body.
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Affiliation(s)
- Pia Kokemohr
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
| | - Lars Haeder
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
| | - Fabian Joachim Frömling
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Landwehr
- Klinik für Diagnostische und Interventionelle Radiologie, Hannover, Germany
| | - Joachim Jähne
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
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