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The Turkish Journal of Gastroenterology
228-229
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To the Editor
Endoscopic removal of an iatrogenically induced rectal foreign body
Özlem YÖNEM, Hilmi ATASEVEN
Department of Gastroenterology, Cumhuriyet University School of Medicine, Sivas
Introduction
To the Editor, Discovery of foreign bodies in the lower gastrointestinal system is rare in clinical practice. Their removal requires experience and attention. Rectal foreign bodies occur either by the oro-anal route or by insertion via the anal canal. Additionally, they can reach the rectum by migration from adjacent organs (1-3). Insertion of foreign bodies into the rectum can be due to autoerotism, sexual or criminal assaults, accidents, or for concealment (2,4). Thermometers and the tip of enemas in the rectum may occur iatrogenically (5).

A female patient was hospitalized in the internal medicine clinic to investigate the etiology of chronic constipation. An enema was applied by a nurse to relieve her constipation. The tip of the enema broke during the application, leaving the tip inside the rectum. She was then consulted to our department. The rectum was empty and no foreign body was palpated during digital rectal examination. Rectosigmoidoscopy was performed in the left lateral decubitus position, and the foreign body was found 12 cm proximal to the anus (Figure 1A). The foreign body was captured with foreign body forceps and then turned parallel to the long axis of the colon and extracted from the anal canal (Figure 1B). Follow-up rectosigmoidoscopic examination after the procedure did not show any complications or even mucosal erosion.

Foreign bodies ingested by mouth generally reach the rectum spontaneously without any problems, leaving the body from the anal canal, having already passed several physiologically narrow sites (5). They reach the outlet with a fibrous diet and by sedation. Foreign bodies that originate from the anal canal can actually be more problematic than those that originate from the oral route. Patients can be asymptomatic or can present with abdominal pain, rectal bleeding, perianal pain, and constipation. Complications such as peritonitis, perforation and obstruction are reported rarely (3,4). They also cannot be detected on plain abdominal radiographs. Rectosigmoidoscopy can be performed both for diagnosis and treatment (6,7). Enema application before the extraction procedure can cause movement of the foreign body to the proximal colon. Thus, extraction procedures should not be carried out blindly, and the clinician should not hesitate in consulting the patient to the surgery department whenever indicated (4).

In conclusion, patients should be informed about all of the procedures that are planned with therapeutic intent, such as obtaining vascular access, intravenous/intramuscular injection(s), rectal drug administration and procedures must be applied carefully by qualified staff.
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  • Introduction
  • References
  • References
    1. Topaloğlu S, Hofl G, Aslan MK. Rektumda yabancı cisime bağlı oluflan intestinal obstrüksiyon: olgu sunumu. Bakırköy Tıp Dergisi 2009; 5: 32-4.

    2. Cohen JS, Sackier JM. Management of colorectal foreign bodies. J R Coll Surg Edinb 1996; 41: 312-5.

    3. Yaman M, Deitel M, Burul CJ, et al. Foreign bodies in the rectum. Can J Surg 1993; 36: 173-7.

    4. Thota PN, Lashner BA. Miscellaneous diseases of the colon. In: Friedman SL, McQuaid KR, Grendell JH, eds. Current diagnosis and treatment in gastroenterology. 2nd ed. New York: Lange Medical Books/McGraw-Hill, 2003; 4878.

    5. Özütemiz Ö. Gastrointestinal kanal yabancı cisimleri. In: Yüceyar H, ed. Gastrointestinal sistem acil hastalıkları. Mart Matbaacılık Sanatları Tic. San. Ltd. fiti., Yıl; 47-52.

    6. Albayrak D, İbifl AC, Hatipoğlu AR ve ark. Rektumda yabancı cisim: üç olgu sunumu. Trakya Univ Tip Fak Derg 2007; 24: 240-3.

    7. Clarke DL, Buccimazza I, Anderson FA, et al. Colorectal foreign bodies. Colorectal Dis 2005; 7: 98-103.
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  • Introduction
  • References
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