Rectal foreign body
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Overview
Rectal foreign bodies are in general, large foreign items found in the rectum that can be assumed to have been inserted through the anus, rather than reaching the rectum via the mouth. Smaller, ingested foreign bodies, such as bones eaten with food, can sometimes be found stuck in the rectum upon x-ray.
Rectal foreign bodies, and amateur attempts to remove them, can result in perforation of the bowel, which is a life-threatening medical emergency. Medical literature covers examples of items retrieved from patients' rectums. Rectal foreign objects are also the subject of a number of urban legends.
Examples of foreign bodies
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Chest X-ray showing a coin in the esophagus of a young child
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A screwdriver with a plastic handle. (Dr. A.K. Sharma, Agra, India
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Gastric foreign body (toothbrush)
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Gastric foreign body (toothbrush)
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Rectal foreign body (Image courtesy of Dr Frank Gaillard)
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This patient collapsed on the ward and was thought to have had a pulmonary embolus. A CTPA revealed a tablet lying dependently in the patient's trachea, with changes of aspiration in both lower lobes (not shown). A second tablet was visible in the stomach... the tablet was removed via a bronchoscope and confirmed to be a Slow K (potassium). (Image courtesy of Dr Frank Gaillard)
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This patient collapsed on the ward and was thought to have had a pulmonary embolus. A CTPA revealed a tablet lying dependently in the patient's trachea, with changes of aspiration in both lower lobes (not shown). A second tablet was visible in the stomach... the tablet was removed via a bronchoscope and confirmed to be a Slow K (potassium). (Image courtesy of Dr Frank Gaillard)
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This patient collapsed on the ward and was thought to have had a pulmonary embolus. A CTPA revealed a tablet lying dependently in the patient's trachea, with changes of aspiration in both lower lobes (not shown). A second tablet was visible in the stomach... the tablet was removed via a bronchoscope and confirmed to be a Slow K (potassium). (Image courtesy of Dr Frank Gaillard)
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Rectal foreign body (Image courtesy of Dr Frank Gaillard)
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Vaginal foreign body (Image courtesy of Dr Donna D'Souza)
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This patient presented with a self-harm injury. The axial CT scan shows a ball-point pen in-situ. The pen missed optic nerve, middle cerebral artery and any eloquent brain. A cerebral angiogram was performed which was normal except for truncation of the ophthalmic artery. The pen was removed under flouroscopic guidance. Upon removal, there was brisk bleeding from the ophthalmic artery. Endovascular embolisation of the bleeding vessel was performed with coils, with good result. The patient’s pupil remains reactive, suggesting a good prognosis for the optic nerve and the patient’s vision. (Image courtesy of Dr Laughlin Dawes)
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A 7 year old girl presented to ED after swallowing a foreign body. Initial CXR shows a foreign body at the level of T8. There was no change in the position of the Mickey Mouse key ring after 8 hours. No pneumomediastinum or pneumothorax. The airway is patent. It was finally retrieved with oesophagoscopy. (Image courtesy of Dr Lily Wang)
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A middle-aged male presented to the emergency department with abdominal discomfort. An abdominal radiograph was performed as shown. There is no evidence of perforation or obstruction. The patient was taken to operating room within 12 hours of presentation, with consent for colostomy. Under general anaesthesia in the lithotomy position, dilatation of anal sphincter was performed and per rectum retrieval successful. These patients typically have a delayed presentation to the emergency department because of embarrassment and after multiple attempts at self removal. Respect for their privacy is a key factor in the patient’s care plan. ED physicians need to decide if removal of foreign body can be performed in the emergency department or surgical team to be notified. Operating room procedures include anal dilatation under GA, transrectal manipulation, bimanual palpation if necessary and withdrawal of foreign body. Laparotomy or laparoscopy are occasionally necessary. (Image courtesy of Andrew Roshan)
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Rectal foreign body. Body packer. (Image courtesy of Dr Frank Gaillard)
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Rectal foreign body (Image courtesy of Dr Frank Gaillard)
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Rectal foreign body (Image courtesy of Dr Frank Gaillard)
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Rectal foreign body (Image courtesy of Dr Frank Gaillard)
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(Image courtesy of Simon Pilgrim and Laughlin Dawes)
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Vaginal pessary for treatment of uterine prolapse (Image courtesy of Dr Frank Gaillard)
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This building-site worker inadvertently stapled-gunned his hand, neatly sitting in his interosseous space. (Image courtesy of Dr Frank Gaillard)
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This trauma patient had significant craniofacial injuries and aspirated a tooth. It lodged in the right lower lobe bronchus, causing post-obstructive consolidation. Inhaled foreign bodies may be complicated by haemoptysis, air trapping, post-obstructive collapse, pneumonia or bronchiectasis. Removal of the foreign body is usually performed via bronchoscopy. (Image courtesy of Dr Donna D'Souza)
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This patient was transfered to ICU from another hospital. On examination of their abdomen a wire was noted to project through the right atrium, down the IVC to end in the right iliac vein. The J-shaped tip gave the game away... a right jugular CVC had been placed, and the wire used for the insertion pushed in with the catheter. This guide wire was successfully retrieved from the groin, without complication. (Image courtesy of Dr Frank Gaillard)
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This patient was transfered to ICU from another hospital. On examination of their abdomen a wire was noted to project through the right atrium, down the IVC to end in the right iliac vein. The J-shaped tip gave the game away... a right jugular CVC had been placed, and the wire used for the insertion pushed in with the catheter. This guide wire was successfully retrieved from the groin, without complication. (Image courtesy of Dr Frank Gaillard)
References in the media
- The television show ER makes several references to this, such as when Dr. Benton holds up a lower abdominal x-ray with a flashlight lodged in it, noting, "The patient claimed that he fell on it while changing a lightbulb. Naked." Another episode has a medical student asking Dr. John Carter about the oddest object removed from a rectum. Dr. Carter responds that it was a bowling trophy.
- The television show Scrubs has made two references to this phenomenon. In "My Two Dads" Turk gives his then girlfriend Carla a pen from what he thinks is the lost and found box, only to discover that the hospital has no lost and found box, and he has mistakenly given his girlfriend a pen from the "Ass Box," comprised entirely of items removed from peoples rectums. The second was when a patient came in with a lightbulb in his rectum, and Dr. Cox, Turk and the Janitor work together to figure out a way to remove the bulb without breaking it.
- The television show House also made two references to rectal foreign bodies. In the first, Gregory House is tending to a clinic patient who refuses to sit, from which he deduces the object's size and location. Upon learning the patient has an MP3 player in his rectum, House asks "Is it because of the size, the shape ... or the pounding bass-line?". The second reference comes when House is confronting his boss, Lisa Cuddy, explaining that the object he has won him second place in the "Weirdest Object Pulled From A Bodily Orifice" and that she does not want to know what the first place-getter was, but it does rhyme with "fucchini".
- On an episode of Seinfeld, George Costanza's father falls on a small sculpture that Cosmo Kramer made, resulting in it being lodged in Mr. Costanza's rectum.
References
- Busch D B, Starling J R. Rectal foreign bodies: Case reports and a comprehensive review of the world's literature. Surg 1986; 100: 512-519. See also the 1995 Literature laureates of the Ig Nobel Prize.
External links
- Cynsa's Rectal Foreign Bodies page
- eMedicine gastrointestinal emergency medicine
- Medical Journal of Australia
- Royal College of Surgeons of Edinburgh
- British Dental Journal case report: Don't forget your toothbrush! (subscribers only - with useful bibliography)