Abdominal Discomfort

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A middle-aged male presented to the emergency department with abdominal discomfort. An abdominal radiograph was performed as shown. There is no evidence of perforation or obstruction.
The patient was taken to operating room within 12 hours of presentation, with consent for colostomy. Under general anaesthesia in the lithotomy position, dilatation of anal sphincter was performed and per rectum retrieval successful.
These patients typically have a delayed presentation to the emergency department because of embarrassment and after multiple attempts at self removal. Respect for their privacy is a key factor in the patient’s care plan. ED physicians need to decide if removal of foreign body can be performed in the emergency department or surgical team to be notified. Operating room procedures include anal dilatation under GA, transrectal manipulation, bimanual palpation if necessary and withdrawal of foreign body. Laparotomy or laparoscopy are occasionally necessary.

References:
1. Cohen JS and Sackier JM. (1996) Management of colorectal foreign bodies. J Roy Coll Surgical Ed. Vol 41:3, pg 12-5
2. Bhanot A, Patel GR, Bachani M, Gohil VD. (2006) Laproscopic assisted removal of rectal foreign body. Indian J Surg

Credit: Andrew Roshan