A review of selected cases of foreign bodies per rectum, and the associated complications and removal. Presentation given to general surgery residency program at Cornell, New York Downtown Hospital winter 2011

1. Review of case studies and management

2. What you should get out of this
 Understand the epidemiology
 Know how to classify the location
 Get a general idea of the options available for trans-
anal removal
 Understand the indications for laparotomy
 Anticipate potential complications

3. Important Considerations
 Most common cause of foreign body per rectum is
auto-erotica
 More common in Men than women
 Retrospective study over a 5 year period involving 28
cases showed
 23 with foreign body lodged
 5 with perforations
 2 were women and both cases non-perforated
 Can you guess where the study took place?

4. Considerations Cont.
 Turkish Journal of Trauma & Emergency Surgery
report: “Retained rectal bodies are a common
presentation worldwide”
 Eftaiha et al. classified colorectal foreign bodies as
low- or high-lying.
 Low-lying objects are those that can usually be removed
in the emergency department transanally
 High-lying foreign bodies up in the rectum can pose a
challenge and require anesthesia, endoscopy or a
laparotomy
 Arch Surg 1977;112:691-5

5. When should we “cut”
 Kingsley et al. proposed that laparotomy should be
considered as the primary method of treatment if the
patient presents with a high-lying foreign body
impacted for 24 hours or longer
 Dis Colon Rectum 1985;28:941-4
 Crass et al. reported that all free perforations were
clinically obvious with free air on abdominal
radiographs
 Am J Surg 1981;142:85-8.

6. Quick Anatomy
 Anal canal: 5 cm
 Rectum: 12 cm
 Sigmoid colon: 40 cm
 Descending colon: 15 cm
 Transverse colon: 45 cm
 Ascending colon: 25 cm

7. True or False?
-Man Vs Tanning
Spray
-22 cm in
length
-Rigid
construction
-Blunt ends
-Including
plastic cap

8. Case # 1
 19 y/o M presenting 12 hours after insertion of high
pressure Tanning spray container into rectum
 Plain abdominal films showed container in recto-sigmoid
area with no signs of perforation
 Flexible sigmoidoscopy was used to visualize object
 Failed manual extraction on bimanual examination
 What happens next?
A. Open Laparotomy
B. Obstetrical Vacuum
C. Dilation and forceps removal
D. Balloon dilatation and traction

11. True of False?
-Man Vs. Garden
hose with Water
Balloon
-11 inches in length
-Soft construction
-Semi rigid shape

12. Case # 2
 59 y/o M presented 8 hours after lodging a homemade
prostate massager in rectum
 Construction from garden hose, with balloon tip
inflated with water
 Patient fell while stepping out of tub forcing object
inside
 Object entered the gut 14 INCHES!
 Object was palpable on DRE
 No perforation was noted
 What is the next best step in management?

14. More statistics
 Of the 23 patients found with retained rectal bodies, 15 were
successfully treated in the ER
 8 patients required overnight hospital admission with removal the
following day
 4 were removed in the endoscopy suite
 4 were removed in the operating room under general anesthesia
 Laparotomy was NOT performed on ANY patient
 Foreign bodies found in the study were
 11 battery powered vibrators of various sizes
 5 hard rubber phallus like devices
 2 bananas
 2 bottles
 1 plastic toothbrush container
 1 apple
 1 onion

15. Can you identify the object?

16. New differential for chest pain
 71 y/o M w/ no PMH, admitted to coronary unit c/o chest
pain radiating to epigastrum with episodes of vomiting
 Pt admitted to inserting plastic coated metal object per
rectum 3 days prior to presentation
 PE: abd soft, mild tenderness in epigastric
 No rebound, no gaurding
 DRE showed palpable foreign body
 Lab work was unremarkable
 EKG normal
 Imaging showed 40cm X 3cm body extending from rectum
to the RUQ and NO FREE AIR

18. Post-op
 Foreign body was removed transanally
 POD # 1
 Abd soft NT/ND, normal abd Xray
 POD # 2
 Pt tachycardic, and showing peritoneal signs
 Laparotomy showed fecal peritonitis, and the recto-
sigmoid colon was resected
 Pt recovered and was DC’d 6 weeks later
 What caused the perforation to occur 5 days later?

21. Guess the method

22. Guess the method