CASE 5711 Published on 26.02.2007

A Case Presentation of Retained Rectal Foreign Body

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

J.L. Morgan, H.N. Khan

Patient

19 years, male

Clinical History
The patient presented with large deodorant can imbedded within the rectum. Examination per rectum and plain abdominal x-ray confirmed the presence of a metallic gas-filled canister within the rectum.
Imaging Findings
The patient presented with a 1 hour history of inserting a metal deodorant can, approximately 15cm in length, “cap” first into the anus and the canister becoming lodged within the rectum. He described mild, dull, lower abdominal pain with no further symptoms. He was otherwise fit and healthy with no concurrent medications. Clinical examination revealed a soft, non-tender abdomen with a suprapubic palpable mass. The patient was not peritonitic and bowel sounds were normal. On rectal digital examination the canister was palpable, there was no anal sphincter damage or blood on the glove. The patient had a plain abdominal x-ray, which revealed the metallic gas-filled canister lodged within the rectum and possibly entering the sigmoid colon. There was also evidence of some large and small bowel dilatation. The patient underwent an Examination under Anaesthesia with removal of foreign body from the rectum. The canister, along with the cap, was removed with ease with the patient in the litotomy position. Rigid sigmoidoscopy was performed to 20cm with no abnormality found. There was no bleeding or obvious mucosal tear. The patient was admitted to the surgical ward post-op for routine observation and analgesia for 24 hours, however he self-discharged after 6 hours as he was well and complained of no pain. There was no follow-up of this patient.
Discussion
There are four scenarios in which foreign bodies are usually introduced into the anus: 1) instrumentation for diagnostic or therapeutic reasons, 2) self-administered treatment, 3) criminal assault, 4) autoeroticism[1]. The most common of these four scenarios, although the least reported, is probably the latter[2]. The highest incidence of autoeroticism occurs in homosexuals, lesbians and masochists. There are numerous reports in the literature concerning interesting and exotic foreign bodies, including bottles[3,4,5], a broom handle[6], an umbrella handle[7], a light bulb[8], a plantain (banana)[9], onions[10], and an apple[11]. Butters[12] reported possibly one of the most unusual incidents where a man placed a lighted “firecracker” inside a tube and inserted this into the rectum. This resulted in an explosion that perforated the anterior wall of the rectum above the level of the prostate. Another unusual rectal foreign body includes that presented by Gustafson et al[13], where a fetus seemed to have eroded into the rectum. Diagnosis of rectal foreign bodies is usually made by history, digital examination of the rectum, sigmoidoscopy and abdominal x-ray[4]. Although many rectal foreign bodies can be removed through the anus, simply by finger extraction, removal is not always so straightforward. Many ingenious methods of extraction of rectal foreign bodies have been described[3], including bimanual abdominal and rectal manipulation, packing breakable objects in cotton or plastic bags before fragmenting them and use of obstetric forceps and tonsil snares. In conclusion, there are many instances where rectal foreign bodies have been described of many different natures and because of the potential complications they should be regarded seriously and treated appropriately.
Differential Diagnosis List
Large "deodorant can" foreign body in the rectum.
Final Diagnosis
Large "deodorant can" foreign body in the rectum.
Case information
URL: https://www.eurorad.org/case/5711
DOI: 10.1594/EURORAD/CASE.5711
ISSN: 1563-4086