ABSTRACT
In the recent years‚ rectal foreign body cases are seen more commonly in the emergency services. Especially it is seen more often in middle aged men who have homosexual orientation. For these people medical history should be taken carefully and the treatment plan must be done accordingly. In this article we will present rectal foreign bodies in five cases admitted to the emergency service.
Introduction
Rectal foreign body is a problem which is seen increasingly more frequent in general surgical emergency departments together with its rising complications.1 The most frequently seen conditions for admittance to hospital with rectal foreign body are generally being elderly ones, mentally retarded individuals, rectal foreign body placed by people due to sexual fantasies, sexual abuse or assault; whereas very rarely it may be a foreign body taken orally but obstructing the rectum.2,3 Although it is not reported as a frequent condition in the literature of our country during 1990s, currently it emerges more frequently in clinics and emergency departments nowadays.4 In this article, we present five reported cases seen at emergency departments with rectal foreign body.
Discussion
Although the rectal foreign bodies in the literature of our country had been reported in less numbers in the past 1990s, it was observed that they are more frequently seen and the number of such cases reported at emergency services increased in recent years.4 Generally, these cases are over middle age and homosexual male individuals. The foreign body penetrated through anal canal due to a sexual fantasy remains rectum and because of the failure of pulling out becomes a reason for admittance to emergency service.2 While the foreign bodies like vibrator, bottle, battery, cap, eggplant implemented in rectum through anal canal generally because of erotic purposes come across, also the foreign bodies like toothpick, needle, dental prothesis are rarely seen as rectal foreign bodies.5 Similarly, our cases were mostly over middle age and it was observed that all of them had tendency to erotic purposes.
The most evident complaint of these patients are usually fullness and pain of anal region.2,6 These complaints were present in all of our cases. A cautious approach must be performed for these cases admitting to emergency service and anamnesis should be taken in details. It must be kept in mind that digital rectal examination is the constant part of physical examination and if there is a foreign body, for the signs of perforation a direct X-ray graphy and if necessary further advanced imaging methods like computerized tomography should be considered. The location of the foreign body is so important that the treatment plan should be due to this location.7 Especially the statements of the patient are very important considering that their first statements may be missing but when you provide confidence and get detailed anamnesis they would tell all the true information about foreign body in the rectum clearly. If possible, foreign body removal by anal dilatation under sedation should be tried.8 Especially the sharp and perforator devices, glass materials in rectum require more caution and laparotomy should be considered by informing the patient in cases of being unable to remove the the foreign body through the anal canal.2 If the foreign body is above the rectosigmoid junction or leads to perforation, then laparatomy and if necessary stoma should be applied.9
As a conclusion, rectal foreign body should be kept in mind in diagnosis of patients admitting to emergency service with a complaint fullness and pain around anal region and so a detailed anamnesis should be provided. When there is no sign of perforation and the foreign body is reachable, to remove it through the anal canal should be the first option to try, but if there is a perforation or complication (perforated cases, septic conditions, bad general condition etc.), then an operation at surgical operation room conditions should be applied and if required laparatomy or stoma methods should be performed.
