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Frendt E, Masroor M, Saied A, Neeki A, Youssoffi S, Malkoc A, Dong F, Tran L, Borger R, Wong DT, Neeki M. Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis. Cureus 2023; 15:e49413. [PMID: 38149151 PMCID: PMC10750084 DOI: 10.7759/cureus.49413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.
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Affiliation(s)
- Eric Frendt
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Momin Masroor
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arman Saied
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arianna Neeki
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Santana Youssoffi
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Aldin Malkoc
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Fanglong Dong
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Louis Tran
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Rodney Borger
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - David T Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Michael Neeki
- Emergency Department, California University of Science and Medicine, Colton, USA
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
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Loria A, Marianetti I, Cook CA, Melucci AD, Ghaffar A, Juviler P, Temple LK, Jones CMC, Fleming FJ. Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021. Am J Emerg Med 2023; 69:76-82. [PMID: 37060632 DOI: 10.1016/j.ajem.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Presentations to the emergency department for rectal foreign bodies are common, but there is little epidemiologic information on this condition. This limits the ability to provide evidence-based education to trainees regarding the populations affected, the types and frequency of foreign bodies, and factors associated with hospitalization. To address this, we analyzed national estimates of emergency department presentations for rectal foreign bodies from 2012 to 2021 in the US. METHODS We queried the National Electronic Injury Surveillance System for any injury to the 'pubic region' or 'lower trunk' with an accompanying diagnosis of foreign body, puncture, or laceration. Two authors manually reviewed all clinical narratives to identify cases of rectal foreign bodies. National estimates were determined using weighting and strata variables, incidence rates calculated using census data, trends assessed by linear regression, and factors associated with hospitalization identified by multivariable logistic regression. RESULTS From 885 cases, there were an estimated 38,948 (95% CI, 32,040-45,856) emergency department visits for rectal foreign bodies among individuals ≥15 years from 2012 to 2021. The average age was 43, 77.8% were male, 55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization. The annual incidence of presentations for rectal foreign bodies increased from 1.2 in 2012 to 1.9 per 100,000 persons in 2021 (R2 = 0.84, p < 0.01). Males have a bimodal age distribution peaking in the fifth decade, while females have a right-skewed age distribution peaking in the second decade. Female sex (odds ratio [OR] 0.4; 95% confidence interval [CI], 0.2-0.6) and, compared to sexual devices, balls/marbles (OR 0.2; 95% CI, 0.05-0.6) or drugs/paraphernalia (OR 0.1; 95% CI, 0.05-0.4) are associated with a reduced odds of hospitalization. CONCLUSIONS Presentations to the emergency department for rectal foreign bodies increased for males and females from 2012 to 2021 in the United States. These epidemiologic estimates for a complex form of anorectal trauma provide preclinical information for emergency medicine, surgery, and radiology trainees.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Ila Marianetti
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Caitlin A Cook
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Aqsa Ghaffar
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Juviler
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Yang Z, Xin P, Zhou S, Zhou C, He X, Bao G. Systematic review of rectal foreign bodies in older men: humanistic care and a novel challenge for society. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:164. [PMID: 35280427 PMCID: PMC8908176 DOI: 10.21037/atm-22-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Background In recent years, rectal foreign bodies have become a common proctological emergency in the male population, especially older Chinese men, often requiring surgical intervention due to associated complications. This review aimed to describe the epidemiology and clinical characteristics of rectal foreign bodies in older men and examine the possible challenges presented by the condition to clinicians and society. Methods A comprehensive search was conducted in English-language databases and Chinese databases from January 2000 to December 2020. Studies concerning rectal foreign bodies were considered for this review if they reported the reason for a foreign body being in the rectum and related treatment measures. Contemporaneous rectal foreign bodies case data from General Surgery Department of Tangdu Hospital were also analyzed. According to differences in ethnicity, the older male patients were divided into a Chinese group and a non-Chinese group, and the parameters of the two groups were analyzed using statistical methods. Results A total of 159 studies were retrieved in an initial database search using “rectal foreign body” as the search term. These included 86 Chinese studies and 73 English-language studies. Collectively, these studies included 582 older male patients, 276 of whom were Chinese, and 307 who were non-Chinese. According to their source, the rectal foreign bodies were classified into 3 categories. The most common reason for a foreign body in the rectum was insertion for erotic purposes, with everyday articles accounting for most foreign body types. Sexual articles were mainly found to have been used in the pursuit of pleasure. There were no significant differences in foreign body sources, sizes, types, treatment selections, and outcomes between the two groups. Discussion Emergency hospital visits by older men with rectal foreign bodies due to erotic and sexual needs and practices are increasing. Although the sources, sizes, and types of foreign bodies were different, and patients recovered well after active and appropriate clinical treatment, the sexual needs of older men are a social issue that requires attention. Acknowledging and dealing with sexual issues is a multidimensional task that requires a collaborative effort to ensure a more humanistic approach to older patients.
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Affiliation(s)
- Zhenyu Yang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Peiyuan Xin
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Shuai Zhou
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chuxin Zhou
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xianli He
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Guoqiang Bao
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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Lefcourt T, Ku A, Issagholian L, Neeki AS, Retamozo M, Dong F, Neeki MM. Novel Bedside Utilization of Foley Catheter in the Emergent Removal of Colorectal Foreign Body: A Case Report and Literature Review. Cureus 2021; 13:e20217. [PMID: 35004037 PMCID: PMC8729319 DOI: 10.7759/cureus.20217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Rectal foreign bodies (RFBs) present unique challenges to the emergency physician. Failure to emergently remove the RFB may lead to additional intraoperative procedures with increased likelihood of complications. We present a case of retained RFB in the emergency department, in which the usual standard approaches to transanal removal had failed. A last-ditch effort by utilizing a Foley catheter inside the object rather than around it led to the successful removal of the RFB. An intense review of the literature highlights the importance of using various novel applications of a Foley catheter to consider cases of RFBs.
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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Gupta SV, Kumar J, Sehgal S, Khemka S. Impacted Large Unusual Rectal Foreign Bodies: a Case Series. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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RECTAL FOREIGN BODY PRESENTING AS CHRONIC DIARRHEA: A CASE REPORT. Gastroenterol Nurs 2021; 44:55-59. [PMID: 33464767 DOI: 10.1097/sga.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022] Open
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Schoppel K, McCarthy M, Macnow T. A 5-Year-Old Girl With Mild Traumatic Shoulder Pain. J Emerg Med 2020; 59:e251-e253. [PMID: 32917448 DOI: 10.1016/j.jemermed.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Kyle Schoppel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Madeline McCarthy
- Department of Pediatrics, University of Massachusetts Memorial Children's Medical Center, Worcester, Massachusetts
| | - Theodore Macnow
- Department of Pediatrics, University of Massachusetts Memorial Children's Medical Center, Worcester, Massachusetts
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Nastoulis E, Karakasi MV, Alexandri M, Thomaidis V, Fiska A, Pavlidis P. Foreign Bodies in the Abdominal Area: Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 62:85-93. [PMID: 31663500 DOI: 10.14712/18059694.2019.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this paper is to update and summarize the relevant literature on the anatomical localization, incidence, and diagnostic and therapeutic approaches to abdominal foreign bodies. A comprehensive review was carried out on recorded cases related to the presence of foreign bodies in the abdominal area throughout the literature. Moreover, the phenomenon was discussed in relation to different patient categories associated with childhood, mental or neurological illness, incarceration, and drug trafficking as well as sexual accident or abuse. Particular importance is ascribed to the underlying psychopathology and motivation of foreign body ingestion in each category of patients. The surgical, psychiatric and legal implications of the issue are discussed in detail.
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Affiliation(s)
- Evangelos Nastoulis
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece.
| | - Maria-Valeria Karakasi
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece.,Third University Department of Psychiatry, AHEPA University General Hospital - Department of Mental Health, Aristotle University - Faculty of Medicine, GR 54124 Thessaloniki, Greece
| | - Maria Alexandri
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece
| | - Vasileios Thomaidis
- Department of Anatomy, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Democritus University of Thrace, School of Medicine, GR 68100 Dragana, Alexandroupolis, Greece
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Kim JH, Um E, Jung SM, Shin YC, Jung SW, Kim JI, Heo TG, Lee MS, Jun H, Choi PW. The Management of Retained Rectal Foreign Body. Ann Coloproctol 2020; 36:335-343. [PMID: 32054243 PMCID: PMC7714380 DOI: 10.3393/ac.2019.10.03.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience. Methods We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes. Results All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling. Conclusion Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.
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Affiliation(s)
- Ju Hun Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Myung Soo Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Shaban Y, Elkbuli A, Ovakimyan V, Wobing R, Boneva D, McKenney M, Hai S. Rectal foreign body causing perforation: Case report and literature review. Ann Med Surg (Lond) 2019; 47:66-69. [PMID: 31645940 PMCID: PMC6804320 DOI: 10.1016/j.amsu.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/29/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background Clinicians must maintain an index of suspicion to diagnose an anorectal foreign body (FB). The patient may not be forthcoming with information secondary to embarrassment or possibly psychiatric issues. Providers must express empathy and compassion while maintaining nonjudgmental composure. Despite accounts of anal FB insertion, this pathology is lacking level one evidence-based surgical algorithms. Case presentation A 46-year-old male psychiatric patient presented in septic shock, complaining of lower abdominal/pelvic pain starting 1 week prior. His past medical history was significant for schizophrenia, bipolar disorder, and noncompliance with medications. CT of the abdomen/pelvis revealed a rectal perforation with free air and a FB which appeared to be a screwdriver. Fluid resuscitation and broad-spectrum antibiotics were administered. In the operating room, after unsuccessful transrectal removal, an exploratory laparotomy was performed. The metallic end of the screwdriver had perforated the rectosigmoid. Resection of the perforated rectum with removal of the screwdriver, incision and drainage of a large right buttock abscess and colostomy was performed. The patient recovered and was discharged to behavioral health. At 2 weeks follow-up the patient was doing well with a functioning colostomy and reversal was planned for later this year. Conclusion This case highlights the importance of maintaining a high index of suspicion when encountering psychiatric patients with nonspecific lower abdominal or anorectal pain with inconsistent presentations. Controversy exists regarding the type of surgical treatment in case of anorectal perforation. More research is needed to provide surgeons with evidence-based standardized methods for dealing with these rare pathologies. Maintaining a high index of suspicion when encountering patients with nonspecific lower abdominal and/or rectal pain. Despite the numerous reports of anal FB trauma there are no cases documenting a unique incident with a screwdriver being inserted through the anus. Controversy exists regarding the type of surgical treatment.
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Affiliation(s)
- Youssef Shaban
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Vasiliy Ovakimyan
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Rachel Wobing
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
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12
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Pfählungsverletzungen und rektale Fremdkörper. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Popa F, Grigoroiu M, Georgescu ME. Intrarectal Foreign Body Detected at CT Scanner Investigating an Abdominal Syndrome. Case Rep Surg 2019; 2019:9134735. [PMID: 30881723 PMCID: PMC6387721 DOI: 10.1155/2019/9134735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
The field of general surgery offers many different pathologies, cases, and situations for which the general surgeons should be competent in diagnosis as well as treatment and management, including operative intervention. Most situations are complicated by delayed admission to the hospital due to the embarrassment of patient and inability to obtain satisfactory anamnesis. This article reviews the use of computed tomography as a problem-solving tool in the identification, localization, and presurgical planning for extracting the rectal foreign object.
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Affiliation(s)
- Florina Popa
- Department of General Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Madalina Grigoroiu
- Department of Morphological and Functional Sciences, “Dunarea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania
| | - Monica Elia Georgescu
- Department of Morphological and Functional Sciences, “Dunarea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galati, Romania
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Kumar P, Rehman S, Rana AKS. Approach to rectal foreign body: an unusual presentation. BMJ Case Rep 2018; 2018:bcr-2018-224253. [PMID: 29804075 DOI: 10.1136/bcr-2018-224253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Foreign bodies in the rectum are commonly confronted worldwide in the surgical emergency. Such a situation arises either accidentally or for autoerotic purposes. A wide variety of foreign objects have been reported in the literature and this usual object would add to the reports for its unusual location. We report a case of a 26-year-old young man with accidental insertion of hand shower in the rectum and no signs of any active bleed or peritonism. Extraction was done successfully in the operating room under general anaesthesia, with an uneventful postprocedure period and the patient was discharged after 48 hours of observation. Rectal foreign bodies can be of wide variety and can lead to life-threatening conditions. An orderly approach is required for diagnosis, management and evaluation in the postprocedure period.
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Affiliation(s)
- Peeyush Kumar
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Samar Rehman
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Anil Kumar Singh Rana
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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15
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Robertson WJ. 'Believe it or not': the medical framing of rectal foreign bodies. CULTURE, HEALTH & SEXUALITY 2017; 19:815-828. [PMID: 28060572 DOI: 10.1080/13691058.2016.1263874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Medical and lay attention to and intervention for rectal foreign bodies, the presence of an object in the rectum most often via insertion through the anus, has long been a source of humour and suspicion in both medical and public discourses. How do the ways medical providers write and talk to each other about rectal foreign bodies shape and reflect understandings of gender, sexuality and the (im)proper use of the anus and rectum? This paper examines the medical literature on rectal foreign bodies to shed light on the ways in which medical providers frame rectal foreign bodies. It develops a set of six frames that demonstrate how the medical literature on rectal foreign bodies (re)produces a variety of normative assumptions about and sociocultural values concerning bodies and sexuality, danger, shame, deception, mental illness and medical professionalism. It concludes with a discussion of how these framings of rectal foreign bodies might potentially contribute to the ongoing stigmatisation not only of rectal foreign body patients, but of non-heteronormative sexualities in general.
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16
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Ghazanfar MA, Guy R. Tablespoons and corkscrew: a culinary solution for retrieval of a rectal foreign body. ANZ J Surg 2017; 87:523. [PMID: 28585759 DOI: 10.1111/ans.14019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Richard Guy
- Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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17
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Kokemohr P, Haeder L, Frömling FJ, Landwehr P, Jähne J. Surgical management of rectal foreign bodies: a 10-year single-center experience. Innov Surg Sci 2017; 2:89-95. [PMID: 31579741 PMCID: PMC6754005 DOI: 10.1515/iss-2017-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Patients with a rectal foreign body (RFB) are still a rare entity in general surgery departments but with an increasing incidence over the last years. This case is sometimes difficult to treat, and due to a lack of standardized treatment options, the aim of the study was to present our clinical experiences with the diagnostic and therapeutic approach to RFBs and a review of the currently available literature. Materials and methods Data were collected retrospectively from the patient’s records of 20 patients who were treated due to an RFB between 2006 and 2016. Patient’s demographics, circumstances of insertion, inserted objects, clinical presentation, laboratory and imaging results, as well as surgical treatment and duration of hospital stay were analyzed. Additionally, a review of the literature was performed with the search items “rectal foreign body” and “surgical therapy”. Because many publications were just case reports, we did not perform a meta-analysis or a systematic review. Results Twenty-two cases in 20 patients (80% male) presented to the emergency room. The mean age was 38.5±13.7 years. In 68.2% of the cases, the cause of RFB was due to sexual preferences. The following objects were inserted: six dildos, three vibrators, two bottles, one glass, one deodorant, one apple, one fever thermometer, multiple glass fragments and razor blades in one patient and six unknown objects. For 18 RFBs, manual peranal removal without anesthesia was possible in the emergency room, but two patients required intravenous analgesia. Two patients were transferred to the operating room and the foreign body was removed via the anus under general anesthesia. Open surgery with a laparotomy was necessary for two complicated cases. One patient was in need of surgery due to a vacuum generated by the RFB, whereas the second patient suffered from a sigmoid perforation. In all cases, there was no morbidity or mortality. Conclusion In most cases, the removal of an RFB can be performed peranally in the emergency room without further complications, therefore representing the therapy of choice for RFB. Only in cases with perforation, acute abdomen, or failed peranal approaches, surgery is indicated to remove the foreign body.
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Affiliation(s)
- Pia Kokemohr
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
| | - Lars Haeder
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
| | - Fabian Joachim Frömling
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Landwehr
- Klinik für Diagnostische und Interventionelle Radiologie, Hannover, Germany
| | - Joachim Jähne
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Marienstraße 72-90, D-30171 Hannover, Germany
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Cawich SO, Thomas DA, Mohammed F, Bobb NJ, Williams D, Naraynsingh V. A Management Algorithm for Retained Rectal Foreign Bodies. Am J Mens Health 2017; 11:684-692. [PMID: 27903951 PMCID: PMC5675215 DOI: 10.1177/1557988316680929] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 01/25/2023] Open
Abstract
Few authors have proposed therapeutic protocols to manage retained rectal foreign bodies (RFBs). All patients with retained RFBs in hospitals across Trinidad and Tobago over 5 years were identified. Hospital records were retrieved and manually reviewed to extract the following data: demographics, history, foreign body retrieved, clinical signs at presentation, management strategy, duration of hospitalization, and morbidity and mortality. There were 10 patients with RFBs over the study period. The annual incidence of this phenomenon was 0.15 per 100,000 population. All patients were men at a mean age of 50.6 years (range: 27-83; SD = 15.3) who presented after a voluntary delay of 1.4 days (range: 0.5-2.5; SD = 0.7). Only one patient gave an accurate history on presentation, but all eventually admitted to self-insertion for sexual gratification. At presentation, one patient had a spontaneous rectal perforation (10%). The remaining nine patients had attempts at bedside transanal extraction, which was unsuccessful in 89% (8/9) of cases. The RFB was pushed beyond the grasp of forceps, making removal under anesthesia unsuccessful in 62.5% (5/8) cases. These patients required more invasive extraction methods including transanal minimally invasive surgery (1), laparoscopic-assisted advancement with transanal retrieval (1), and open surgery with transmural extraction and anastomoses (3). A management algorithm is proposed for the management of RFBs. Important points in this algorithm are the importance of clinician-patient rapport, early surgical referral, avoidance of bedside extraction in the emergency room, early examination under anesthesia, and the inclusion of emerging therapies such as transanal minimally invasive surgery.
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Affiliation(s)
- Shamir O. Cawich
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Dexter A. Thomas
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fawwaz Mohammed
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nahmorah J. Bobb
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Dorothy Williams
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- The University of the West Indies, St. Augustine, Trinidad and Tobago
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19
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Cheong JY, Keshava A. Management of colorectal trauma: a review. ANZ J Surg 2017; 87:547-553. [DOI: 10.1111/ans.13908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ju Yong Cheong
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Anil Keshava
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School; The University of Sydney; Sydney New South Wales Australia
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20
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Ayantunde AA, Unluer Z. Increasing trend in retained rectal foreign bodies. World J Gastrointest Surg 2016; 8:679-684. [PMID: 27830039 PMCID: PMC5081549 DOI: 10.4240/wjgs.v8.i10.679] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/11/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.
METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed. Patients’ clinical data and yearly case presentation with data relating to hospital episodes were collected. Data analysis was by SPSS Inc. Chicago, IL, United States.
RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39 (17-62) years and M: F ratio of 2:1. A progressive rise in cases was noted from 2008 to 2012 with 3, 4, 4, 6, 8 recorded patients per year respectively. The majority of the impacted rectal objects were used for self-/partner-eroticism. The commonest retained foreign bodies were sex vibrators and dildos. Ninty-six percent of the patients required extraction while one passed spontaneously. Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction. The mean hospital stay was 19 (2-38) h. Associated psychosocial issues included depression, deliberate self-harm, illicit drug abuse, anxiety and alcoholism. There were no psychosocial problems identified in 15 patients.
CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.
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21
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Khubezov DA, Trushin SN, Puchkov KV, Puchkov DK, Ogorel'tsev AY. [Treatment of rectal foreign bodies]. Khirurgiia (Mosk) 2016:57-63. [PMID: 27723697 DOI: 10.17116/hirurgia2016957-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to present the results of treatment of rectal foreign bodies. MATERIAL AND METHODS 15-year outcomes of 112 patients with rectal foreign bodies were analyzed. RESULTS Outpatient and hospital care were applied in 52 (46%) and 60 (54%) of cases respectively. Transanal removal was made in 97 (87%) patients including 28 (25%) cases of general anaesthesia. 14 (13%) patients underwent surgery. Colostomy was performed in 7 (6%) cases. We presented cases of foreign bodies removal through laparotomy, colotomy and SILS-assisted transanal approach. DISCUSSION From clinical point of view foreign bodies should be first of all classified by their dimensions. Anamnesis and physical examination are very important. Abdominal X-ray survey is obligatory. Transanal removal under general anaesthesia is advisable if perforation is absent. If such procedure is impossible laparotomy is indicated. CONCLUSION Algorithm of survey and treatment is presented.
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Affiliation(s)
- D A Khubezov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - S N Trushin
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - K V Puchkov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - D K Puchkov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - A Yu Ogorel'tsev
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
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22
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Elmoghrabi A, Mohamed M, Wong K, McCann M. Proctalgia and colorectal stricture as the result of a 2-year transit of a retained rectal chicken bone: a case presentation and review of the literature. BMJ Case Rep 2016; 2016:bcr-2016-215913. [PMID: 27325671 DOI: 10.1136/bcr-2016-215913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 70-year-old woman who presented with progressively increasing intensity of lower abdominal, pelvic and rectal pain of 3-day duration. She had similar symptoms intermittently over the preceding 2 years. CT of the abdomen and pelvis revealed the presence of a 3.8×0.4 cm linear foreign body in the colorectal region. History obtained from relatives recalled inadvertent ingestion of a chicken bone 2 years prior to presentation. Trials of foreign body retrieval, both manually and via rigid and flexible sigmoidoscopy, however, were unsuccessful due to the presence of obstruction by a circumferential rectal stricture. Consequently, an exploratory laparotomy was performed, with segmental resection of 17 cm of rectum and distal sigmoid. Dissection of the strictured segment revealed the presence of a chicken bone. The patient had an uneventful postoperative course, was discharged and is to continue following up on an outpatient basis.
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Affiliation(s)
- Adel Elmoghrabi
- Department of Trauma Services, Hurley Medical Center, Flint, Michigan, USA
| | - Mohamed Mohamed
- Department of Trauma Services, Hurley Medical Center, Flint, Michigan, USA
| | - Kristoffer Wong
- Department of Trauma Services, Hurley Medical Center, Flint, Michigan, USA
| | - Michael McCann
- Department of Trauma Services, Hurley Medical Center, Flint, Michigan, USA
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Yahya A, Chukwuma J. Retrospective Audit of the Management of Anal Insertion of Foreign Bodies: A Holistic Approach. Prim Care Companion CNS Disord 2016; 18:15br01864. [PMID: 27247831 DOI: 10.4088/pcc.15br01864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022] Open
Abstract
Most patients with voluntary anal insertion of a foreign body (IFB) present to the emergency department and are then managed by the surgical team. This report reviews the medical literature on IFB and includes results of a chart review of operative logged interventions and clinically coded procedures for anal IFBs at a single acute hospital in the United Kingdom between May 2009 and September 2013. The objective was to establish the current practice in the management of anal IFB and update a framework for the initial workup, surgical procedure, and appropriate mental health intervention.
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Affiliation(s)
- Ahmed Yahya
- Department of Psychiatry, Chase Farm Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, Middlesex, United Kingdom
| | - Jude Chukwuma
- Department of Psychiatry, Chase Farm Hospital, Barnet, Enfield and Haringey Mental Health NHS Trust, Middlesex, United Kingdom
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24
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Im CJ, Na JH, Kim HS, Ha SS, Lim YL, Lee JH, Choi HK, Kim HM. Successful removal of a foreign body by endoscopic balloon dilatation at the colonic stricture. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chang Jo Im
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hoon Na
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Sik Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Sam Ha
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoo Li Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyeon Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Kyoung Choi
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Man Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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25
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Obinwa O, Robertson I, Stokes M. Removal of a sex toy under general anaesthesia using a bimanual-technique and Magill's forceps: A case report. Int J Surg Case Rep 2015; 15:96-8. [PMID: 26322821 PMCID: PMC4601957 DOI: 10.1016/j.ijscr.2015.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/23/2022] Open
Abstract
A case of a 68-year-old male with large bowel obstruction due to the presence of a phallic object in the rectum is presented. Removal of the phallic object was achieved using a pair of Magill’s forceps and bi-manual manipulation under general anaesthesia. This case demonstrates the use of Magill’s forceps to aid removal of a foreign body in the rectum. Laparotomy and open removal may, therefore, be rarely necessary.
Introduction Phallic objects may cause large bowel obstruction if not promptly removed. A bi-manual technique with the aid of a Magill’s forceps is presented here. Presentation of case A 68-year-old man presented to the emergency department with severe lower abdominal discomfort, distension and inability to pass urine, flatus or bowel motions. He had inserted a phallic object in the rectum 10 hours prior to presentation and had been unable to remove same. Abdominal examination was remarkable for distension with tenderness also elicited suprapubically and in the left iliac fossa. The foreign body was barely palpable per rectum. Plain radiographs showed prominent left-sided colonic segments. Following the trial of a manual attempt at removal in the emergency department, a decision was made to remove this under anaesthesia due to worsening symptoms. The phallic object was successfully removed under general anaesthesia using bi-manual manipulation assisted by a pair of Magill’s forceps. Discussion The method of removal of phallic objects varies from one individual case to another. In the presence of obstruction, a quick decision must be made for removal under general anaesthesia and the patient will also need to be consented for laparotomy. Previous literature described a “cork-in-bottle” technique using myomectomy screws as well as use of single-incision laparoscopic surgery (SILS) ports for removal of phallic objects. Conclusion Extraction of phallic objects requires ingenuity. We describe another minimally invasive technique of removal that adds to the literature, thereby limiting the need for laparotomy and open removal of foreign bodies.
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Affiliation(s)
- Obinna Obinwa
- Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
| | - Ian Robertson
- Department of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
| | - Maurice Stokes
- Consultant Surgeon and Senior Lecturer in Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
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Pinto A, Miele V, Pinto F, Mizio VD, Panico MR, Muzj C, Romano L. Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects. Semin Ultrasound CT MR 2015; 36:88-93. [DOI: 10.1053/j.sult.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Sun HJ, Lee J, Kim DM, Chu MS, Park KS, Choi DJ. Rectal perforation caused by a sharp pig backbone in a middle-aged patient with mild depression. Yeungnam Univ J Med 2015. [DOI: 10.12701/yujm.2015.32.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hyeong Ju Sun
- Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Jeonghun Lee
- Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Dong Min Kim
- Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Myeong-Su Chu
- Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Kyoung Sun Park
- Department of Internal Medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Dong Jin Choi
- Department of General Surgery, Daejeon Sun Hospital, Daejeon, Korea
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28
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Hamid R, Bhat N, Wani SA, Baba A. Unusual rectal foreign body in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Elias B, Debs T, Hage S, Bassile B, Hanna P, Saint Eve P. Single incision laparoscopic surgery technique for transanal removal of rectal foreign body. J Surg Case Rep 2014; 2014:rju022. [PMID: 24876403 PMCID: PMC4197915 DOI: 10.1093/jscr/rju022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/28/2014] [Indexed: 11/12/2022] Open
Abstract
A foreign body in the rectum is not a very common surgical emergency case. In the treatment of rectal foreign bodies, the aim is to use the simplest possible method while protecting the integrity of the intestine. Many removal techniques have been described in the literature. Here we report a case in which a transanal technique using a single incision laparoscopic surgery port was successfully used.
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Affiliation(s)
- Bachir Elias
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
| | - Tarek Debs
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
| | - Said Hage
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
| | - Bashir Bassile
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
| | - Philippe Hanna
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
| | - Patrick Saint Eve
- General Surgery Department, CHR Metz-Thionville, Bel-Air Hospital, Thionville, France
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30
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Yoshie N, Nakao A, Ishimaru E, Terashima M, Yamada T, Kotani J. Unusual rectal foreign bodies: a case report and review of published works. Acute Med Surg 2013; 1:61. [PMID: 29930823 DOI: 10.1002/ams2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Norichika Yoshie
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
| | - Atsunori Nakao
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
| | - Eizaburo Ishimaru
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
| | - Mariko Terashima
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
| | - Taihei Yamada
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan.,Department of Surgery Osaka Gyomeikan Hospital Osaka city Japan
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Abstract
Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The approach includes a careful history and physical examination, a high index of suspicion for any evidence of perforation, a creative approach to nonoperative removal, and appropriate short-term follow-up to detect any delayed perforation.
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Affiliation(s)
- Kyle G Cologne
- Division of Colon and Rectal Surgery, Department of Surgery, The University of Southern California, Los Angeles, California
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Yildiz SY, Kendirci M, Akbulut S, Ciftci A, Turgut HT, Hengirmen S. Colorectal emergencies associated with penetrating or retained foreign bodies. World J Emerg Surg 2013; 8:25. [PMID: 23849062 PMCID: PMC3717008 DOI: 10.1186/1749-7922-8-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/10/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Foreign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem. METHODS Data were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed. RESULTS All the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out. CONCLUSION A careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.
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Affiliation(s)
- Selim Yigit Yildiz
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaelı, Izmit, Turkey
| | | | - Serkan Akbulut
- Department of Surgical Oncology, Ankara University Medical School, Ankara, Turkey
| | - Ali Ciftci
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaelı, Izmit, Turkey
| | - Hamdi Taner Turgut
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaelı, Izmit, Turkey
| | - Suleyman Hengirmen
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Abate G, Shirin M, Kandanati V. Fournier gangrene from a thirty-two-centimeter rectosigmoid foreign body. J Emerg Med 2012. [PMID: 23200766 DOI: 10.1016/j.jemermed.2012.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical and surgical problems associated with rectal foreign bodies are rare. Although most rectal foreign bodies can be removed without subsequent sequelae, they pose significant risk of infection. OBJECTIVES We report a patient with a 32-cm rectosigmoid foreign body and subsequent development of Fournier gangrene despite successful removal of the foreign body. CASE REPORT A 63-year-old Caucasian man with past medical history of diabetes mellitus and depression presented with a chief complaint of "something stuck in my intestine." He admitted that he placed a foreign body in the rectum. Abdominal X-ray study and computed tomography of the abdomen/pelvis showed a conical-shaped 32-cm rectosigmoid foreign body. The foreign body was removed manually and follow-up colonoscopy was done. The patient's condition deteriorated in the first 2 days of hospital stay and he was diagnosed with Fournier gangrene. He required multiple surgeries and received broad-spectrum antibiotic coverage for mixed bacterial flora grown from deep tissue. CONCLUSION Rectal foreign bodies can cause Fournier gangrene. A close observation and follow-up is important after removal of rectal foreign bodies.
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Affiliation(s)
- Getahun Abate
- Division of Infectious Diseases, Department of Internal Medicine, Saint Louis University, St. Louis, MO 63104, USA
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Ayantunde AA. Approach to the diagnosis and management of retained rectal foreign bodies: clinical update. Tech Coloproctol 2012; 17:13-20. [PMID: 22993140 DOI: 10.1007/s10151-012-0899-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/06/2012] [Indexed: 12/14/2022]
Abstract
Retained rectal foreign body is not an uncommon condition, but reliable epidemiological data are not available. The diagnosis and management can present a significant challenge due to delayed presentation and the reluctance of the patients to provide details of the incident. The aim of the clinical evaluation is to identify the type, number, size, shape and location of the foreign body. Removal of retained rectal foreign bodies requires experience, with particular attention to different methods of extracting various objects. Most retained rectal foreign bodies can be successfully extracted transanally under appropriate anaesthesia and only a small proportion, mostly cases of perforation, overt peritonitis, pelvic sepsis or for failure of transanal extraction, will require open surgery or laparoscopy. It is mandatory to perform a proctosigmoidoscopy after anorectal foreign body removal to exclude bowel injury and ensure that the patient has not inserted more than one foreign body. Patients with mucosal abrasion, tears and oedema are to be admitted for a period of observation.
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Affiliation(s)
- A A Ayantunde
- Department of Surgery, Colorectal Unit, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK.
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Aminsharifi A, Afsar F, Jafari M, Tourchi A. Removal of an entrapped large metallic dilator from the sigmoid neovagina in a male-to-female transsexual using a laparoscopic approach. Int J Surg Case Rep 2012; 3:266-8. [PMID: 22504480 DOI: 10.1016/j.ijscr.2012.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 02/25/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION To describe the role of laparoscopy for removal of entrapped vaginal metallic dilator (20cm in length and 3.5cm in diameter) in a case of male-to-female transsexual. PRESENTATION OF THE CASE The patient was a 24-year old male-to-female transsexual, presented with entrapment and upward migration of the vaginal metallic dilator 1 week before admission. She underwent gender reassignment surgery with sigmoid vaginoplasty 8 month before admission. After 3-port transperitoneal laparoscopic abdominopelvic exploration, through an incision over the sigmoid vagina the dilator was extracted. The sigmoid vagina was repaired with free-hand intracorporeal laparoscopic suturing and knot-tying techniques in two layers and the dilator was removed by extending the site of umbilical port. The operative time was 70min. DISCUSSION Up to 60% of rectosigmoidal or vaginal foreign bodies can be extracted transanally or transvaginally with adequate sedation. When surgical exploration is indicated, a longitudinal laparatomy is performed to extract the foreign body. To reduce the associated morbidity of an open procedure in our patient, we performed a laparoscopic approach for complete abdominal exploration for possible presence of intestinal or sigmoidal injuries together with removal of this large metalic dilator. CONCLUSION Laparoscopic approaches in cases of neovaginal foreign body are useful when the endovaginal approaches have failed, especially in transsexual patients, to prevent another major open surgery.
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Affiliation(s)
- A Aminsharifi
- Department of Urology, Laparoscopic Research Center, Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ryoo SB, Oh HK, Ha HK, Choe EK, Moon SH, Park KJ. Operative treatment with a laparotomy for anorectal problems arising from a self-inserted foreign body. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:56-60. [PMID: 22413083 PMCID: PMC3296944 DOI: 10.3393/jksc.2012.28.1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/02/2022]
Abstract
An anorectal foreign body can cause serious complications such as incontinence, rectal perforation, peritonitis, or pelvic abscess, so it should be managed immediately. We experienced two cases of operative treatment for a self-inserted anorectal foreign body. In one, the foreign body could not be removed as it was completely impacted in the anal canal. We failed to remove it through the anus. A laparotomy and removal of the foreign body was performed by using an incision on the rectum. Primary colsure and a sigmoid loop colostomy were done. A colostomy take-down was done after three months. The other was a rectal perforation from anal masturbation with a plastic device. We performed primary repair of the perforated rectosigmoid colon, and we didea sigmoid loop colostom. A colostomy take-down was done three months later. Immediate and proper treatment for a self-inserted anorectal foreign body is important to prevent severe complications, and we report successful surgical treatments for problems caused by anorectal foreign bodies.
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Affiliation(s)
- Seung-Bum Ryoo
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Vaquero LM, García M, Álvarez B, Pisabarros C, Sierra M, Diez R, Vivas S. [Terminal ileitis of uncommon etiology]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:608-9. [PMID: 22398378 DOI: 10.1016/j.gastrohep.2012.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/08/2012] [Indexed: 11/18/2022]
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Abstract
In adults, rectal foreign bodies are a well-described phenomenon. In the pediatric emergency department, however, insertion of foreign bodies into the rectum is a rarely seen condition. Herein, we discuss a case of a rectal foreign body in a 13-year-old boy and the modality of removal.
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Kasotakis G, Roediger L, Mittal S. Rectal foreign bodies: A case report and review of the literature. Int J Surg Case Rep 2011; 3:111-5. [PMID: 22288061 DOI: 10.1016/j.ijscr.2011.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 11/26/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Rectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful. PRESENTATION OF CASE In this article we report the case of a male who presented with a large ovoid rectal object wedged into his pelvis. As we were unable to extract the object with routine transanal and laparotomy approach, we performed a pubic symphysiotomy that helped widen the pelvic inlet and allow transanal extraction. DISCUSSION We review currently available literature on RFB and propose an evaluation and management algorithm of patients that present with RFB. CONCLUSION Management of patients with rectal foreign bodies can be challenging and a systematic approach should be employed. The majority of cases can be successfully managed conservatively, but occasional surgical intervention is warranted. If large objects, tightly wedged in the pelvis cannot be removed with laparotomy, pubic symphysiotomy should be considered.
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Affiliation(s)
- G Kasotakis
- Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States
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Transanal endoscopic microsurgery: long-term experience, indication expansion, and technical improvements. Surg Endosc 2011; 26:312-22. [PMID: 21898025 DOI: 10.1007/s00464-011-1869-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 08/01/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to review the authors' 16-year experience with transanal endoscopic microsurgery (TEM). Mortality, morbidity, recurrence rate, and functional outcome were assessed. New indications and technical improvements are presented. METHODS From November 1991 to August 2008, 123 patients (72 men and 51 women; median age, 68 years; range, 21-91 years) underwent TEM for excision of 105 adenomas with low- or high-grade dysplasia, 9 invasive adenocarcinomas (5 curative and 4 palliative resections), 2 neuroendocrine tumors, and 2 extramucosal lesions. Five additional patients had excisional biopsies, allowing staging after previous endoscopic resection. Most of the resections were full-thickness rectal resections using electrocautery or, more recently, the Harmonic scalpel. The latest mucosectomies were performed using the endoscopic submucosal dissection (ESD) technique. In addition, nontumoral indications included pelvic abscess (7 patients) and rectal strictures, which were either anastomotic or chemical. Pelvic abscesses were drained transrectally, whereas rectal stenoses were treated by strictureplasty. Foreign object retrieval and collagen plug placement for anal fistulas were performed using TEM in three patients. RESULTS No mortality occurred. One intraoperative rectal perforation required conversion to laparotomy. The postoperative complications included one pneumoperitoneum, which was treated medically, and one rectal perforation requiring Hartmann's procedure. In the polyp subgroup, six patients (6/91, 7%) experienced local recurrence. Pelvic abscesses were successfully treated, and stenosis did not recur after strictureplasty. Anorectal manometry showed functional alterations without significant clinical impact. CONCLUSIONS The findings showed TEM to be a safe and effective procedure for local excision of rectal lesions with a low recurrence rate and minimal consequences in terms of anorectal function. In addition, TEM proved to be feasible and effective for pelvic abscess drainage and rectal stenosis treatment. New technologies such as the Harmonic scalpel and ESD increase the precision already offered by this approach.
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Jung EJ, Ryu CG, Kim G, Hwang DY. Impaction of a foreign body in the rectum by improper use of a (electronic) massager: a case report. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:298-301. [PMID: 21152233 PMCID: PMC2998008 DOI: 10.3393/jksc.2010.26.4.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 06/14/2010] [Indexed: 10/26/2022]
Abstract
A male, 67 years old, visited the emergency room because of a foreign body impacted in his rectum. While he was being treated for grade-II hemorrhoids conservatively, he heard that massage of the peri-anal area could be helpful for preventing hemorrhoids. Thus, while using an electronic massager after placing the head of the machine into a short round bar, the head became separated from the machine, and this was inserted into the anus and impacted. The patient had anal discomfort without abdominal pain. His vital signs were stable, and no abnormal physical findings were found for the abdomen. On digital rectal examination, the rim of the foreign body was palpated about 8 cm from the anal verge. Anal bleeding, abnormal discharge, or foul odor was not found. On a simple abdominal X-ray, a radio-opaque foreign body was observed in the pelvic cavity, and mild leukocytosis was noted on the laboratory test. To avoid injury to the anal sphincter, we tried to remove the foreign body under the spinal anesthesia. After anesthesia had been administered, the foreign body was palpated more distally at 5-6 cm from the anal verge by digital examination, and the foreign body was found to have a hole in its center. This was held using a Kelly clamp, and with digital guiding, was removed through the anus. After removal, an anoscopic examination was performed to determine if mucosal injury had occurred in the rectum or anal canal. The patient was discharged without complication after 24 hours of close observation.
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Affiliation(s)
- Eun-Joo Jung
- Colorectal Cancer Center, Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Hesham A-Kader H. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr 2010; 6:301-10. [PMID: 21080143 DOI: 10.1007/s12519-010-0231-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 03/03/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND Foreign body ingestion is a common problem in the pediatric age group. Infants and young children explore objects by putting them in the mouth. DATA SOURCES We reviewed the most recent literatures regarding the incidence, clinical presentation, as well as the most recent advances in the diagnostic and therapeutic modalities of foreign body ingestion in children. RESULTS In 2007 more than 125 000 foreign body ingestions in patients of 19 years old and younger were reported to American Poison Control Centers in the USA. The majority of ingested foreign bodies pass spontaneously. CONCLUSIONS Some foreign bodies can be harmful and require evaluation and intervention. The challenge in management is to distinguish the patients who require intervention from those who can be safely observed. In this review we suggest an algorithm for evaluation and management of children suspected to ingest a radiopaque foreign body.
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Affiliation(s)
- H Hesham A-Kader
- Department of Pediatrics, The University of Arizona, Tucson, AZ 85750, USA.
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Abstract
AIM To perform a systematic review of the published reports on retained colorectal foreign bodies (CFBs) to collate the features and formulate a simple management plan based on the available evidence. METHOD An extensive search was carried out to identify articles on CFBs. The search was carried out on electronic databases Cinahl, Embase, Medline, PubMed and PsychInfo from 1950 to January 2009. Internet journals were also scoured and a general search was carried out using the search engine 'Google'. Papers published in languages other than English were not included. RESULTS This review covers a total of 193 patients with 196 presentations. There were 188 men and 5 women, a ratio of approximately 37:1. The mean age at presentation was 44.1 years (SD 16.6) in the single case reports and 39.3, 40 and 60.8 years in the three case series. Household objects, such as bottles and glasses, accounted for the largest percentage (42.2%) of inserted objects. Presentation for treatment occurred most often within 24 h of insertion and the majority of objects were removed transanally using manual manipulation with or without the use of a variety of tools, or via a scope. CONCLUSIONS The incidence of CFBs is disproportionately higher in men. Various techniques for removal are available, including some that are minimally invasive. The appropriate technique will depend on the size and surface of the retained object and the presence of complications such as perforation or obstruction.
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Affiliation(s)
- M A Kurer
- Department of General Surgery, Colorectal Unit, York Hospital, York, UK
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Abstract
Rectal foreign bodies present a difficult diagnostic and management dilemma because of delayed presentation, a variety of objects, and a wide spectrum of injuries. An orderly approach to the diagnosis, management, and post-extraction evaluation of the patient with a rectal foreign body is essential. This article outlines and describes the stepwise evaluation and management of the patient with a rectal foreign body. The authors also describe the varied techniques needed to successfully remove the different foreign bodies that may be encountered.
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Rodrigues GS, Lobo DN. A foreign body in the rectum. Indian J Surg 2010; 72:74. [PMID: 23133212 DOI: 10.1007/s12262-010-0017-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 02/26/2009] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gabriel Sunil Rodrigues
- Division of Gastrointestinal Surgery, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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Kulkarni AA, Abhyankar SV, Chaudhari GS, Singh RR, Bhatia SH. Simple and effective method of heat therapy in lymphoedema. Indian J Surg 2010; 72:64-5. [PMID: 23133208 DOI: 10.1007/s12262-010-0013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/26/2009] [Indexed: 11/30/2022] Open
Abstract
Heat therapy is a well known conservative management for lymphoedema. We are describing here a heat therapy apparatus which is easy to make, cheap, transportable, easily reproducible and maintenance free and found to be very effective.
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Affiliation(s)
- Ananta A Kulkarni
- Department of Plastic Surgery, Padmashree Dr D. Y. Patil Hospital and Research Centre, Sector -5, Nerul, Navi Mumbai, Maharasthra 400 706 India
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Arora S, Ashrafian H, Smock ED, Ng P. Total laparoscopic repair of sigmoid foreign body perforation. J Laparoendosc Adv Surg Tech A 2009; 19:401-3. [PMID: 19245310 DOI: 10.1089/lap.2008.0242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We describe the case of a 43-year-old male who presented with lower abdominal pain following rectal foreign body introduction and self-removal. Clinical examination revealed generalized peritonitis with pneumoperitoneum on Erect Chest X-ray. At laparoscopy a perforation in the sigmoid colon was found and successfully repaired. In view of contamination, the bowel proximal to the perforation was exteriorized as a loop colostomy without conversion to open laparotomy. The patient was discharged home four days later: He subsequently underwent successful reversal of his colostomy at four months. Herein we present to the best of our knowledge the first case in the literature of a successful total laparoscopic repair of sigmoid perforation resulting from transanal foreign body abuse.
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Affiliation(s)
- Sonal Arora
- Department of Biosurgery and Surgical Technology, Imperial College, London, United Kingdom.
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Abstract
Rectal foreign body impaction in infancy is extremely rare, and the literature does not describe a standard treatment procedure. Extraction by fiberoptic rectosigmoidoscope is advocated as the treatment of choice but is not free of possible complications. It should be also taken into consideration that the type of foreign body has an impact on the timing of treatment. We report a 50-day-old male presenting with a retained broken tip of a mercury thermometer in the rectum. A novel method of diagnostic approach and treatment is discussed.
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Billoud E, Savoye G, Hervé S, Ramirez S, Lerebours E. Double J ureteral stent as an unusual endoscopic finding in a patient with rectal bleeding. Gastrointest Endosc 2008; 68:1239-40. [PMID: 18555247 DOI: 10.1016/j.gie.2008.02.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 02/27/2008] [Indexed: 12/10/2022]
Affiliation(s)
- Emilie Billoud
- Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France
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