Rectal Foreign Bodies

The surgical management of two patients presenting with incarcerated, apparently self-inserted foreign bodies is reported. The large volume of prior literature on this subject is reviewed, with tabulation of 182 previous cases by type and number of objects recovered and with a discussion of patients' age distribution, history, complications and prognosis.

Table I Previously reported recovered foreign bodies:

[ed. note: list has been appended to reflect recently found documentation.]

Object                             Number Recovered

Glass or ceramic
   Bottle or jar                       32
   Bottle with attached rope            1
   Glass or cup                        12
   Light bulb                           7
   Tube                                 6
Food
   Apple                                1
   Banana                               2
   Carrot                               4
   Cucumber                             3
   Onion                                2
   Parsnip                              1
   Plantain (with condom)               1
   Potato                               1
   Salami                               1
   Turnip                               1
   Zucchini                             2
Wooden
   Ax handle                            1
   Stick or broom handle               10
   Miscellaneous or unspecified         3
Sexual Device
   Vibrator                            23*
   Dildo                               15
Kitchen device
   Dull knife                           1
   Ice pick                             1
   Knife sharpener                      1
   Mortar pestle                        2
   Spatula (plastic)                    1
   Spoon                                1
   Tin cup                              1
Miscellaneous tools
   Candle                               1
   Curling Iron				1
   Flashlight                           3
   Iron rod                             1
   Pen                                  2
   Rubber tube                          1
   Screwdriver                          1
   Toothbrush                           1
   Wire spring                          1
Inflated device
   Balloon                              1
   Balloon attached to cylinder         1
   Condom                               1
Ball
   Baseball                             2
   Tennis ball                          1
   Pool cue ball                        1
Miscellaneous containers
   Baby powder can                      1
   Candle box                           1
   Shampoo Bottle			1
   Snuff box                            1
Miscellaneous
   Bottle cap **                        1
   Cattle horn                          3
   Chain (gold)				1
   Frozen pig's tail                    1
   "Kangaroo tumor" #                   1
   Hair Mousse Cap			1
   Plastic rod                          1
   Stone                                2
   Toothbrush holder                    1
   Toothbrush package                   1
   Whip handle                          2*
Collections (one case of each)
  2 Glass tubes
  72 1/2 Jeweler's saw
  Oil can with potato stopper
  Piece of wood, peanut
  Umbrella handle and enema tubing
  2 Glasses
  Phosphorus match ends (homicide)
  402 Stones
  Toolbox ##
  2 Bars soap
  Beer glass and preserving pot
  Lemon and cold cream jar
  2 Apples
  Spectacles, suitcase key, tobacco pouch, and magazine
 total of 14 collections, with approximately 500 objects

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* number may be larger (text unclear)
**cannot exclude ingestion
# unique case of pedunculated perianal skin tumor habitually
   inserted into rectum
##inside a convict; contained saws and other items usable 
in escape attempts.

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Case 1. A 39-year-old married white male lawyer presented with a self- inserted perfume bottle in his rectum that he was unable to remove using various objects, including a back scratcher. He had inserted this bottle on previous occasions. Edema of the rectum and sigmoid colon precluded the successful manual removal of the object in the emergency room. A pelvic x-ray film (Fig.1) showed the object to be lodged 12 cm proximal to the dentate line. The 3 by 17 cm object, "Impulse Body Spray," was removed manually after a spinal anesthetic. The patient was discharged on the second postoperative day. He refused psychologic counseling.

Case 2. A 39-year-old white male was admitted to the University Hospital psychiatric service for evaluation of a 2-week history of bloody diarrhea and auditory hallucinations. Rectal examination revealed a foreign body approximately 3 cm above the anal verge. An x- ray film (Fig. 2) showed that it was 20 cm in length. The object could not be removed by manual or endoscopic means. The patient consented to extraction of the dildo under general anesthetic. Biopsy specimens of the hemorrhagic rectal mucosa were performed and were negative on Ziehl-Neelson stains for mycobacterial or cryptosporidium infection. The patient was discharged without complications the following day.

Rectal Foreign Bodies, additional casestudies.

cynsa@well.com