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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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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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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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Lodhia J, Msuya D, Chilonga K, Makanga D. Successful Transabdominal Removal of Penetrating Iron Rod in the Rectum: A Case Report. East Afr Health Res J 2022; 5:137-141. [PMID: 35036838 PMCID: PMC8751478 DOI: 10.24248/eahrj.v5i2.663] [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: 11/03/2020] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Foreign bodies in the anus and rectum are not uncommon presentations globally. Reasons for foreign bodies in the rectum can be trauma, assault, psychiatric reasons but the most common reason documented is sexual pleasure, and objects range from sex toys to tools to packed drugs. Regardless of the reason, health care providers must maintain nonjudgmental composure and express empathy. Numerous cases have been reported of anorectal foreign body due to various causes. Removal of the objects has mostly been through rectally but some does need surgical intervention. A multidisciplinary approach and radiologic investigations are important to guide in the management outline. Establishment of guidelines for anorectal foreign bodies are needed to guide surgeons and emergency physicians on the course of treatment. We present a case of an eleven-year old school boy slid and fell on an iron rod that penetrated his rectum through his anal canal. Presented with clinical features of peritonitis, where emergency laparotomy was done and the iron rod was extracted abdominally with primary repair of the rectum. The boy recovered well and was discharged four days after with no complications.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Kondo Chilonga
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Danson Makanga
- Department of General Surgery, Mpeketoni Hospital, Lamu County, Kenya
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Kumar P, Rehman S, Rana AKS. Approach to rectal foreign body: an unusual presentation. BMJ Case Rep 2018; 2018:bcr-2018-224253. [PMID: 29804075 DOI: 10.1136/bcr-2018-224253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Foreign bodies in the rectum are commonly confronted worldwide in the surgical emergency. Such a situation arises either accidentally or for autoerotic purposes. A wide variety of foreign objects have been reported in the literature and this usual object would add to the reports for its unusual location. We report a case of a 26-year-old young man with accidental insertion of hand shower in the rectum and no signs of any active bleed or peritonism. Extraction was done successfully in the operating room under general anaesthesia, with an uneventful postprocedure period and the patient was discharged after 48 hours of observation. Rectal foreign bodies can be of wide variety and can lead to life-threatening conditions. An orderly approach is required for diagnosis, management and evaluation in the postprocedure period.
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Affiliation(s)
- Peeyush Kumar
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Samar Rehman
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Anil Kumar Singh Rana
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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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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