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      Unusual Rectal Foreign Body: A Golf Ball

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          Abstract

          An 18-year-old man presented to the emergency department with a lower abdominal pain. He reported that his girlfriend had inserted a golf ball partially into his anus and lost it 6 hours earlier. The physical examination findings were unremarkable. The anus and surrounding area showed no signs of trauma. Plain pelvic/abdominal radiography revealed a 4.5-cm round, opaque foreign body in the pelvic cavity (Fig. 1A). Contrast-enhanced abdominopelvic computed tomography revealed a 4.5-cm spherical foreign body at the junction of the rectum and sigmoid colon; no perforation was found (Fig. 1B). The patient underwent proctosigmoidoscopy without sedation, which revealed a golf ball of 4 cm in diameter, approximately 15 cm from the anus. We initially used a Roth Net retriever (US Endoscopy, Mentor, OH, USA); however, the maximum width was only 3 cm; therefore, we could not grasp the ball completely (Fig. 2A). The ball was finally extracted using a 30-mm stone extraction basket (The Web extraction basket; Cook Inc., Winston‐Salem, NC, USA) and retrieved through the anus with the patient’s cooperation (Fig. 2B, C). We found no mucosal defect or perforation after the removal of the ball through proctosigmoidoscopy. Two hours later, he was discharged after the absence of perforation was confirmed on chest and abdominal radiographs. The incidence of rectal foreign bodies (RFBs) is not known precisely, but RFBs are encountered regularly in most large hospitals. RFBs are reported in all age groups, sexes, and races; however, more than two-thirds of patients are men aged 20 to 30 years [1]. As the use of objects for sexual arousal increases, the number of hospital visits for removal of retained RFBs has increased [2]. Most RFBs have been inserted deliberately by the patient or a sexual partner. Such foreign bodies are likely to be rounded/cylindrical shaped and smooth. The most frequently reported RFBs include bottles, followed by sexual devices, vegetables, fruits, and other household objects. RFB causes difficulties in extraction because several attempts have been made to extract it at home. A basic principle of management for a patient with a foreign body in the rectum is to avoid general anesthesia and laparotomy. Whether the object can be removed via the anus is determined by the shape, size, location, duration, and presence of perforation. RFBs may require a surgical approach if the following risk factors are present: hard or sharp objects, impaction of an object of 10 cm in length, migration of the object upward into the sigmoid colon, impaction of the object for >2 days, and presence of perforation [3]. After several attempts to grasp the foreign body, endoscopists must consider more innovative options for the extraction of the RFB without iatrogenic injury. In this case, we initially used a Roth Net retriever to remove the golf ball. The size of the Roth Net retriever was smaller than that of the golf ball; furthermore, the golf ball was slippery, and the retriever was unable to grasp the ball completely. Subsequently, a stone extraction basket used for endoscopic retrograde cholangiopancreatography was used for the retrieval. The 30 mm stone extraction basket was pushed toward the rectal wall to increase the space between the wires, and the golf ball was inserted in the wire to hold it completely and tightly. Sometimes, placing the patient in a different position may be helpful to facilitate removal. As demonstrated in this case, using a stone extraction basket for removing RFBs is a safe and useful method.

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          Most cited references3

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          Management of retained colorectal foreign bodies: predictors of operative intervention.

          This study was designed to review experience at our hospital with retained colorectal foreign bodies. We reviewed the consultation records at Los Angeles County + University of Southern California General Hospital from October 1993 through October 2002. Ninety-three cases of transanally introduced, retained foreign bodies were identified in 87 patients. Data collected included patient demographics, extraction method, location, size and type of foreign body, and postextraction course. Of 93 cases reviewed, there were 87 individuals who presented with first-time episodes of having a retained colorectal foreign body. For these patients, bedside extraction was successful in 74 percent. Ultimately, 23 patients were taken to the operating room for removal of their foreign body. In total, 17 examinations under anesthesia and 8 laparotomies were performed (2 patients initially underwent an anesthetized examination before laparotomy). In the eight patients who underwent exploratory laparotomy, only one had successful delivery of the foreign object into the rectum for transanal extraction. The remainder required repair of perforated bowel or retrieval of the foreign body via a colotomy. In our review, a majority of cases had objects retained within the rectum; the rest were located in the sigmoid colon. Fifty-five percent of patients (6/11) presenting with a foreign body in the sigmoid colon required operative intervention vs. 24 percent of patients (17/70) with objects in their rectum (P = 0.04). This is the largest single institution series of retained colorectal foreign bodies. Although foreign objects located in the sigmoid colon can be retrieved at the bedside, these cases are more likely to require operative intervention.
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            Approach to the diagnosis and management of retained rectal foreign bodies: clinical update.

            Retained rectal foreign body is not an uncommon condition, but reliable epidemiological data are not available. The diagnosis and management can present a significant challenge due to delayed presentation and the reluctance of the patients to provide details of the incident. The aim of the clinical evaluation is to identify the type, number, size, shape and location of the foreign body. Removal of retained rectal foreign bodies requires experience, with particular attention to different methods of extracting various objects. Most retained rectal foreign bodies can be successfully extracted transanally under appropriate anaesthesia and only a small proportion, mostly cases of perforation, overt peritonitis, pelvic sepsis or for failure of transanal extraction, will require open surgery or laparoscopy. It is mandatory to perform a proctosigmoidoscopy after anorectal foreign body removal to exclude bowel injury and ensure that the patient has not inserted more than one foreign body. Patients with mucosal abrasion, tears and oedema are to be admitted for a period of observation.
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              Increasing trend in retained rectal foreign bodies

              AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period. METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed. Patients’ clinical data and yearly case presentation with data relating to hospital episodes were collected. Data analysis was by SPSS Inc. Chicago, IL, United States. RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39 (17-62) years and M: F ratio of 2:1. A progressive rise in cases was noted from 2008 to 2012 with 3, 4, 4, 6, 8 recorded patients per year respectively. The majority of the impacted rectal objects were used for self-/partner-eroticism. The commonest retained foreign bodies were sex vibrators and dildos. Ninty-six percent of the patients required extraction while one passed spontaneously. Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction. The mean hospital stay was 19 (2-38) h. Associated psychosocial issues included depression, deliberate self-harm, illicit drug abuse, anxiety and alcoholism. There were no psychosocial problems identified in 15 patients. CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.
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                Author and article information

                Journal
                Clin Endosc
                Clin Endosc
                CE
                Clinical Endoscopy
                Korean Society of Gastrointestinal Endoscopy
                2234-2400
                2234-2443
                March 2021
                25 May 2020
                : 54
                : 2
                : 291-292
                Affiliations
                Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
                Author notes
                Correspondence: Dong Hoon Baek Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: dhbeak77@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-8416-0615
                http://orcid.org/0000-0003-1512-9475
                http://orcid.org/0000-0003-4933-7790
                http://orcid.org/0000-0001-9721-5734
                http://orcid.org/0000-0003-2100-8522
                Article
                ce-2020-097
                10.5946/ce.2020.097
                8039745
                32447882
                7ee11c7b-bb1e-4136-ae8a-dc9a01f9de4a
                Copyright © 2021 Korean Society of Gastrointestinal Endoscopy

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 April 2020
                : 7 May 2020
                : 7 May 2020
                Categories
                Brief Report

                Radiology & Imaging
                Radiology & Imaging

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