Abstract

A large plastic bottle was removed transanally by using Tenaculum and Myoma Screw in 54 years old male and laparotomy was avoided.

Introduction

Management of Foreign Body in Rectum is done according to the presentations of the patients, in our patient we retrieved Plastic Tooth Powder bottle Transanally5 by using gynaecological instruments like tenaculum and Myoma screw, which is not mentioned in literature, as we are reporting

Case Report

We report a case of 54 year old male presented in emergency hours on with Foreign Body in Rectum.4 Patient inserted the object to attain sexual pleasure.3 No past history of any such incidence.

On examination

Patient was averagely built and nourished with normal vital parameters. Non diabetic and non-hypertensive.

There is a rectangular shaped gas pattern in the upper rectum due to a nonopaque foreign body (plastic bottle) not visible on plain X-ray.

No gas under diaphragm seen.

Surgical Management

Consent for Transanal extraction as well as for Laparotomy taken. Patient was given Spinal anaesthesia and Lithotomy position given. Anoscope introduced which revealed the base of foreign body4 and was around 10-12 inch away from the anal verge. Tenaculum forceps used to grasp the broad base of the foreign body (Plastic bottle), Taking care not to injure the bowel. Bottle was tried to pulled out, but it was getting Horizontal lie during the pull, hence pulling of the bottle abandoned and it was fixed by Tenaculum forcep, at that point and a Myoma Screw (instrument used for Myomectomy) used to pierce the base of the bottle and bottle gradually pulled distally to remove it safely, completely and cost effectively transanally.2,5 It was a “Dabur Tooth Powder” bottle (Figs. 1 and 2).4 After complete expulsion no bleeding or erosion noted in the rectum or anal canal as bottle was of plastic with smooth curves.1

Discussion

The main reasons given by the patient for the presence of foreign bodies include accidental insertion, sexual motives.3

Fig.1

Fig.2

Many different objects have been noted in the literature varying from bottles, vibrators, fruits and vegetables, tools, and miscellaneous items example light bulbs, candles, balls and flashlights.

The age of patients ranges from young to middle-aged. Men are more likely to present than women. Women are more likely to have vaginal foreign bodies. The complications of insertion of these materials include rectal bleeding, mucosal lacerations, anorectal pain, bowel perforations, abscesses and rarely death. The management of these cases varies from simple manual retrieval with or without general anaesthetic or using a sigmoidoscope, folley catheters or even cyanoacralate adhesive attached to the object to aid removal. Laparotomy may need to be performed depending on the object’s size, shape, composition and position.

Conclusion

Use of Tenaculum and Myoma Screw provided a safe,1 cost-effective method of large, plastic foreign body removal by the transanal5 route and Laparotomy was avoided. Literature review found no other reports of rectal foreign body removal by this method.

References

1. Hellinger MD. Anal trauma and foreign bodies. Division of Colon and Rectal Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
2. Huang WC, Jiang JK, Wang HS, et al. Retained rectal foreign bodies. J Chin Med Assoc 2003; 66 (10) : 607-12.
3. Meagher FW. An unusual foreign body in the rectum. New York Medical Journal. Int J Psycho-Anal, September 21, 1921; 3 : 356-7. B.D. (1992) Sexual Life.
4. Foreign bodies in the rectum from Bailey and Love’s Short Practice of Surgery, 21st Edition (Chapman and Hall Medical, 1992) - pages 1219-20.
5. Cohen JS, Sackier JM. Department of Surgery, University of California, San Diego, La Jolla, USA. JR Coll Surg Edinb 1996; 41 (5) : 312-5. (ISSN:0035-8835).

Ron Waksman, The Lancet, 2007; 369 : 881-82.