Saudi Journal of Gastroenterology
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CASE REPORT Table of Contents   
Year : 1997  |  Volume : 3  |  Issue : 2  |  Page : 103-104
Ano-rectal foreign body : A case report


Department of Surgery, Armed Forces Hospital, Riyadh, Saudi Arabia

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Date of Submission09-Sep-1996
Date of Acceptance18-Feb-1997
 

How to cite this article:
El Musharaf HA. Ano-rectal foreign body : A case report. Saudi J Gastroenterol 1997;3:103-4

How to cite this URL:
El Musharaf HA. Ano-rectal foreign body : A case report. Saudi J Gastroenterol [serial online] 1997 [cited 2019 Oct 13];3:103-4. Available from: http://www.saudijgastro.com/text.asp?1997/3/2/103/33936


Ano-rectal foreign bodies are an infrequent occurrence. They are either inserted rectally, eg: broom handles, light bulbs, dildoe, bottles, carrots, vibrator, etc., or ingested and lodged from above, eg: chicken bones, tooth pick, or nail [1],[2] .

A case of ano-rectal foreign body (gas lighter) is presented with some review of the relevant literature. The aim of this is to increase the awareness of the condition which should be regarded seriously and treated expeditiously, and to draw attention to its potential complications.


   Case Report Top


A 23-Year-old man presented with rectal bleeding for a week. Hemodynamically he was stable and systemic examination was unremarkable. Rectal examination revealed an offensive current-gelly discharge and a solid object felt at the tip of the finger which moved upwards during examination. The patient denied the history of trauma or fall astride on any object. Plain X-ray of the abdomen was done [Figure - 1]. The patient then admitted insertion of a cooking gas lighter to relieve rectal discomfort. Chest X-ray was negative for gas under the diaphragm. The patient was taken to the operating room, had prophylactic antibiotic cover and under general anesthesia, in lithotomy position, anal dilation was performed. Transrectal manipulation resulted in the extraction of the gas lighter [Figure - 2]. Sigmoidoscopy demonstrated an ulcer with whitish slough 8cm from anal verge representing the area, where the distal sharp end was lodged. Postoperative course was uneventful. No psychiatric illnesses or signs of psychological instability demonstrated but history of stressful life is noted and hence he was referred for psychosocial counselling.


   Discussion Top


The exact incidence of rectal foreign bodies is unknown. In most cases the patients do not seek medical attention as foreign bodies are passed spontaneously or removed easily by the patient or his partner [3] .

Although the patient presented a week later, the median time of presentation of foreign bodies inserted rectally is 24 hour ranging from 6 to 48 hours [1] . The patient may present with anxiety about the possible rectal damage, rectal bleeding or acute abdomen due to rectal perforation [4] . Usually they do not admit insertion of foreign bodies which may result in late diagnosis with the risk of perforation.

Ano-rectal foreign bodies ingested from above usually present as perianal sepsis as usually they lodge in para-anal tissue, and the range of time of presentation is 48 hours to three months [1] . The etiology of insertion of rectal foreign bodies include anal eroticism, assault, accidents, attempted relief of perianal diseases, stressful social problems, depression and schizophrenia [1] .

Adequate relief of pain and relaxation of anal sphincter are prerequisite for successful withdrawal of rectal foreign bodies and only four percent of cases require laparotomy [3] .

The impact of large foreign bodies above one of the rectal valves, edematous bulging of the rectum distal to the foreign body, or the presence of sharp projection with the risk of perforation, may make the transrectal withdrawal hazardous, and may dictate the need for laparotomy. In addition, of course, to the presence of acute abdomen. Colotomy and primary closure in the absence of gross fecal contamination is considered safe. Colostomy may be indicated in the presence of sepsis or gross fecal contamination [2] .

Various ways reported for the removal of rectal foreign bodies include use of Wrigley's obstetric forceps [5] and the passage of Foley's catheter above the object and then inflating the balloon and withdraw the catheter [6],[7] .

 
   References Top

1.Yaman M, Deitel M, Bural JC, Shahi B, Hadar B. Foreign Bodies in the Rectum.Can. J.S., 1993;36:173-7.  Back to cited text no. 1    
2.Fry Dr. Ano-rectal Trauma and Foreign Bodies. Surg. Clin. North Am., 1994;74:1491-503.  Back to cited text no. 2    
3.Miller JB, Wetzig RN. Incarcerated Sigmoid Bottle. Aust. N.Z. J. Surg., 1990;60:729-31.  Back to cited text no. 3    
4.Campbell KJ. Case Report: A case of rectal perforation by foreign body presenting as pyrexia of unknown etiology. J. Roy. Nav. Med. Serv., 1992;78:13-5.  Back to cited text no. 4    
5.Whatling PJ. An Unusual Delivery (Letter). Br. J. Hosp. Med., 1994;51:615.  Back to cited text no. 5    
6.Gough J. Removal of Alimentary Foreign Bodies (Letter). Br. J. Hosp. Med., 1991;46:270.  Back to cited text no. 6    
7.Colthurst JR. How to remove a rectal foreign body (Letter). Br. J. Hosp. Med., 1990:43:329.  Back to cited text no. 7    

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Correspondence Address:
Hassan A.R El Musharaf
Ward - 36, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB, United Kingdom

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Source of Support: None, Conflict of Interest: None


PMID: 19864804

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