ANALLY RETENTIVE

"Rectal Foreign Bodies" -- from Surgery Magazine (1986)

Collated by Drs. David B. Busch and James R. Starling, Madison, Wis.

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

CASE REPORT

A 20-year-old man presented to the emergency room complaining of rectal pain. A well-nourished, well-developed man without signs of intoxication was admitted in no apparent distress. Digital examination of the rectum revealed a stony hard mass. Abdominal plain films showed a vertically oriented, low-lying radiopaque object in the rectum. A spherical radiolucency was noted in the upper pole of the mass. A blood alcohol level was negative. No other drug testing was performed.

Upon further questioning, the patient said that approximately 4 hrs earlier he and his boyfriend had been "fooling around." After stirring a batch of concrete mix, the patient laid on his back with his feet against the wall at a 45-degree angle while his boyfriend poured the mixture through a funnel into his rectum. After the concrete mass hardened, it became so painful that he sought medical care.

Under general anesthesia, the anus was dilated and two Foley catheters were inserted alongside the rectal mass to relieve suction. A concrete case of the rectum was delivered without incident. The rectal mucosa was intact with a hyperemic and edematous appearance.

The patient was kept overnight and discharged uneventfully the following morning. The attending physician recommended a psychiatric consultation, but the patient declined.