Man slips in shower while washing dog.
Anal Eroticism: Two unusual rectal foreign bodies and their removal
by Drs. Roy W. Graves, E. Jackson Allison, Jr., Robert R. Bass, and Richard C. Hunt<br> from Southern Medical Journal -- Vol.76 No.5
FOREIGN BODIES in the colon and rectum are frequently encountered in busy emergency departments. They are almost always self-administered by male patients. To initiate a discussion of the clinical entity of anal sexual eroticism, we present two cases, that of an elderly male patient with a peanut butter jar lodged in his rectum, and a younger man who had a large plastic vibrator on his rectal shelf.
A 65-year-old man came to the emergency department of an outlying hospital complaining of lower abdominal pain. A large empty glass jar was discovered in the rectum, and the patient was transferred to the regional medical center for its extraction. The patient reported that he was washing his dog in the shower when he slipped and fell on a glass jar, which entered his rectum. Physical and radiologic examinations showed an inverted glass jar, 8 cm in diameter, located just beyond the anal sphincter. The glass was intact and there was no apparent bleeding. After multiple unsuccessful attempts at removal in the emergency department, the patient was taken to the operating room, given spinal anesthesia, and placed in the jack-knife position; the anal region was prepped and the buttocks separated with tape. Through a Robinson catheter, introduced beyond the exterior of the jar, air was insufflated to break the partial vacuum behind the jar. Then, with the patient in the deep Trendelenburg position, the jar was filled with quick-setting two-inch plaster rolls packed around an Army-Navy right-angle retractor and allowed to set. After approximately 15 minutes, the anal sphincter was retracted with right-angle vaginal retractors and gentle finger pressure was used to massage the edematous tissue over the leading edge of the jar as it was rotated gradually and delivered. Examination of the distal sigmoid, rectum, and anus showed only edema, ecchymoses, and minor abrasions. The patient recovered fully after the procedure and was discharged from the hospital the following morning. A 34-year-old man came to the emergency department one evening complaining of rectal and lower abdominal pain after allegedly having been abducted and sexually assaulted by several other men. Abdominal examination revealed a firm mass above the umbilicus, and digital palpation rectally encountered a hard, plastic object at 4 or 5 cm. A roentgenogram showed a large vibrator in the rectum. No free air was detected under the diaphragm, and bowel sounds and vital signs were completely normal. When repeated attempts to extract the vibrator were unsuccessful, the patient was admitted to the hospital, given nothing by mouth, and the next morning was taken to the operating room, where the plastic foreign body was extracted without complication, with the patient under spinal anesthesia. He was observed for 24 hours and discharged. Subsequent police investigation determined that no abduction had occurred, and that the vibrator had most likely been self-administered.
DISCUSSION In one review of colorectal foreign bodies and their management, all patients were male and ostly in the fourth and fifth decades of life. Most often the foreign bodies had been self-introduced. All patients had physical examination, biplane abdominal roentgenograms, and proctosigmoidoscopy to determine location, type, and number of foreign bodies. Transanal manipulation and extraction of the foreign bodies were attempted only after regional anesthesia. After removal, a repeat proctosigmoidoscopic examination was done to assess the condition of the bowel wall, and the patients were then observed for 24 hours for possible complications. Sohn and Weinstein reported more than 100 cases of successful removal of foreign objects in the office, with local, perianal, and submucosal anesthesia. Althought perforation of the bowel wall is not common, one series reported five perforations associated with 28 colorectal foreign bodies. Over the years, a multitude of objects have been removed from the colorectal area, including bottles, candles, fruits, vegetables, vibrators, tumblers, a polyethylene waste trap from the U-bend of a sink, salami, sponge rubber balls, baseballs, sewing needles, marijuana, sandfilled bicycle inner tubing, an aluminum tube (used by a prisoner to store money and other valuables), broomsticks, and glass tubes. Eftaiha and his colleagues outlined the princible of management of colorectal foreign bodies and provided helpful methods of extraction, including the use of Foley catheters with inflated balloons for traction, plaster of Paris in glass containers (first reported in 1949 by Bacon), and obstetric instruments to aid in delivering the objects... There are reports in the literature of colorectal foreign bodies having been in place for months and even years without perforation or other significant complications. The use of enemas and catheters to aid in removal continues to be somewhat controversial.
SUMMARY We have described two cases involving unusual rectal foreign bodies and their subsequent removal. Suggestions are included to aid in the removal of colorectal foreign bodies, as well as references to provide for the appropriate management of these cases in the emergency department. Primary care providers need to be aware of the issue of colorectal foreign bodies as a clinical entity and the fact that their occurrence is expected to continue to rise dramatically. Patient education of the dangers inherent in the insertion of objects into the colorectal area should be more prevalent. At the very least, all physicians need to be aware of anal eroticism and the necessity to take a careful medical history.
Acknowledgments. We thank Jo Bass and Doris Vincent for preparation of this manuscript.
Thanks to Mark Slater (firstname.lastname@example.org) who plucked this gem from the research lib and snailmailed it to me.