Rectal Impaction Following Enema
with Concrete Mix
by Peter J. Stephens, M.D., and Mark L. Taff,
from the American Journal of Forensic Medicine and Pathology
This article describes an unusual rectal foreign
body resulting from homosexual anal erotic activities. The patient
had used an enema containing a concrete mix which became impacted
and required surgical removal. The use, abuse, and complications
of enemas are reviewed.
Key Words: Anal eroticism--Colorectal injuries--Enemas, cement--Foreign
During the last 20 years, sexual habits have changed in western
society. Both homosexuals and heterosexuals have shown an increasing
interest in anal erotic practices, including the use of enemas for
sexual enjoyment. We report a case of a klismaphiliac who had an
impacted foreign body in his rectum followin an enema with a concrete
A 20-year-old man presented to the emergency room complaining
of rectal pain. A well-nourished, well-developed man without signs
of intoxication was admitted in no apparent distress. Digital examination
of the rectum revealed a stony hard mass. Abdominal plain films showed
a vertically oriented, low-lying radiopaque object in the rectum.
A spherical radiolucency was noted
in the upper pole of the mass. A blood alcohol level was negative.
No other drug testing was performed.
Upon further questioning, the patient said that approximately
4 hrs earlier he and his boyfriend had been "fooling around." After
stirring a batch of concrete mix, the patient laid on his back with
his feet against the wall at a 45-degree angle while his boyfriend
poured the mixture through a funnel into his rectum. After the concrete
mass hardened, it became so painful that he sought medical care.
Under general anesthesia, the anus was dilated and two Foley catheters
were inserted alongside the rectal mass to relieve suction. A concrete
case of the rectum was delivered without incident. The rectal mucosa
was intact with a hyperemic and edematous appearance.
The patient was kept overnight and discharged uneventfully the
following morning. The attending physician recommended a psychiatric
consultation, but the patient declined.
Examination of the specimen revealed a perfect concrete cast of
the rectum, measuring 12 X 7 X 5 cm and weighing 275 g (Fig. 2). A thin layer of feces coated the
surface and crevices. Grooves in the mass were consistent with rectal
mucosal folds. A layer of concrete was chipped off the upper part
of the specimen and revealed a white plastic ping-pong ball. This
corresponded to the radiolucency observed in the abdominal x-ray.
Thanx to Mark Slater for digging out this article and to Nate Galbreath
for the photos. --cb
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