How to cite this article: Niaz-Ud-Din, Muhammad Saaiq, Muhammad Zubair, Aatif Inam,

Shabana Jamal, Tanwir Khaliq. An un-usual foreign body in the rectum. Ann Pak Inst

Med Sci 2007; 4(1): 62-3.

CASE REPORT

AN UNUSUAL FOREIGN BODY IN THE RECTUM

AUTHORS:
Niaz-ud-Din,
Muhammad Saaiq,
Muhammad Zubair,
Aatif Inam,
Shabana jamal,
Tanwir Khaliq.
Department of General surgery,
PIMS, Islamabad.

Address for Corresponding :

Dr Niaz-ud-Din,
Postgraduate Resident ,
Department of General surgery,
PIMS , Islamabad.
E-mail: doctor596@yahoo.com

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INTRODUCTION

As such foreign body ( FB ) in the rectum is not uncommon and hence no longer considered

rare.1 It can be caused by anal eroticism, concealment of illegal drugs, attention-seeking

behaviour, assault, accident and occasionally retained ingested foreign bodies.2,3 It can also be

observed in penitentiary prisoners, psychiatric patients, homicide and suicide attempts, erotic

acts, homosexuals, sadomasochistic practice, cases of sexual aggression or rape, people under the

effects of drugs or alcohol and drug carriers.4

A host of different foreign bodies with various sizes and shapes have been described, including

glass bottles, aerosol cans, light bulbs, corn cobs, vibrators, hosepipes, primus stoves, and

packets of marijuana.1

CASE HISTORY:

A 54 years old man presented to the accident and emergency department of PIMS, Islamabad

with pain in the rectum and inability to walk and sit up. On further questioning, he admitted that

he had a foreign body in the rectum, in fact a long bathroom brush which he had introduced into

the rectum for achieving sexual gratification. He had been a heroin addict since long and had

been admitted to rehabilitation centre over the last six months. He was married with four

children and was accompanied by a social worker.

On physical examination he was vitally stable and abdomen was soft and nontender with bowel

sounds audible. On examination of the perianal area, there was a long bathroom brush (Figures

III and IV ) inserted into the rectum and was firmly impacted inside. An effort was made in the

emergency department to remove the foreign body but failed. Consent was taken for possible

laparotomy/ colostomy and the patient was shifted to operation theatre, where the FB was

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removed under spinal anaesthesia in lithotomy position. The rectal mucosa was firmly impacted

into the hook of the brush. Post operatively the patient was shifted to surgical ward for

observation but he left the ward against the medical advice at night.

DISCUSSION

A variety of foreign bodies with various sizes and shapes have been described. The condition

can be classified according to the level with respect to the rectosigmoid junction. Low-lying

foreign bodies are those located inside the rectal ampulla, whereas high-lying foreign bodies lie

at or above the rectosigmoid junction. This classification has been used as a general rule to guide

the method of retrieval.5-7 The FB can be diagnosed by history, physical examination (mainly by

digital rectal examination) and confirmed by plain abdominal radiographs.

For uncomplicated low-lying foreign bodies, transanal extraction can be achieved by digital

manipulation or using various grasping forceps through proctoscopy, anal retractor or rigid

sigmoidoscopy. A vacuum is built up proximal to the foreign body preventing its extraction, a

Foley catheter could be passed proximal to it to overcome the negative pressure. As anal spasm

can hold the foreign body away from anus, adequate relaxation is often needed. In difficult cases,

extraction may require complete relaxation of anal sphincters by local, regional or even general

anaesthesia.8-10

For high-lying foreign bodies, trans-anal extraction can still be successful, but they are more

likely to require a general anaesthesia. For patients presenting with frank peritonitis, laparotomy

is mandatory to remove the foreign body, repair the perforation and perform surgical lavage. A

defunctioning stoma may sometimes be needed. 7-10

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It is imperative not to humiliate or belittle these patients and to treat them with the same amount

of respect we normally show to other patients approaching us for help. Psychologist and

psychiatrist help /support should be also be sought while managing such cases.

REFERENCES

1. Cheung YS, Wong J, Wilson WC Ng, Tam TL, Micah CK Chan, Paul BS. Retrieval of
rectal foreign bodies: a difficult case. Surgical Practice 2007 : 11 : 162–4.

2. Eisen GM, Baron TH, Dominitz JA . Guideline for the management of ingested foreign
bodies. Gastrointest. Endosc. 2002; 55: 802–6.

3. Clarke DL, Buccimazza I, Anderson FA . Colorectal foreign bodies. Colorectal Dis.

2005; 7: 98–103.

4. Rodríguez-Hermosa JI, Codina-Cazador A, Ruiz B, Sirvent JM, Roig J, Farrés R.

Management of foreign bodies in the rectum. Colorectal Disease 2007;9 : 543–8.

5. Cohen JS, Sackier JM. Management of colorectal foreign bodies. J R Coll Surg Edinb.
1996; 41: 312–5.

6. Kingsley AN, Abcarian H. Colorectal foreign bodies. Management update. Dis Colon
Rectum 1985; 28: 941–4.

7. Lake JP, Essani R, Petrone P . Management of retained colorectal foreign bodies:

predictors of operative intervention. Dis. Colon Rectum 2004; 47: 1694–8.

8. Huang WC, Jiang JK, Wang HS . Retained rectal foreign bodies. J Chin Med Assoc
2003; 66: 607–12.

9. Obrador A, Barranco L, Reyes J, Gayà J. Colorectal trauma caused by foreign bodies.

Rev Esp Enferm Dig 2002; 94: 109–10.

10. Shah J, Majed A, Rosin D. Rectal salami. Int J Clin Pract. 2002 ; 56 : 558-9.

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Figure I: Preoperative picture of the patient with FB in situ.

Figure II: Preoperative picture of the patient with FB in situ.

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Figure III: The retrieved FB .

Figure IV: Hook of the brush into which rectal mucosa was firmly impacted.