An Unusual Foreign Body in the Rectum
Case Report
An Unusual Foreign Body in the
Rectum
A middle aged heroin addict who presented to Accident and emergency department with
two hours history of rectal impaction of a long bathroom brush is described. He had
introduced it himself for achieving sexual gratification. It was removed under spinal
anaesthesia. The patient had uneventful recovery in the immediate postoperative phase.
Key words: Rectal foreign body. Anal eroticism.
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 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 Report
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 non-tender 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.
Ann. Pak. Inst. Med. Sci. 2008; 4(1): 62-63
Niaz-ud-Din et.al.
Niaz-ud-Din
Muhammad Saaiq
Muhammad Zubair
Aatif Inam
Shabana Jamal
Tanwir Khaliq
Department of General surgery
PIMS , Islamabad.
Address for Correspondence:
Dr Niaz-ud-Din
Postgraduate Resident
Department of General surgery
PIMS , Islamabad.
E-mail: doctor596@yahoo.com
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 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
62
An Unusual Foreign Body in the Rectum
Figure I: Preoperative picture of the patient with FB in
situ.
Figure II: Lithotomy position of the patient with FB in
situ.
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
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 also
be sought while managing such cases.
References
Ann. Pak. Inst. Med. Sci. 2008; 4(1): 62-63
Niaz-ud-Din et.al.
Figure III: The retrieved FB .
Figure IV: Hook of the brush into which rectal mucosa
was firmly impacted.
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BS. Retrieval of rectal foreign bodies: a difficult case. Surgical
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