Retained Pesticide Bottle in the Rectum

Many kinds of rectal foreign-body (RFBs) insertion into the rectum were reported, such as bottles, cans, vegetables like cucumber or carrots, wood sticks, and sexual devices [1]. The most common motivation for RFB insertion is for sexual stimulation; some others may result from psychiatric illnesses, concurrent illicit drug usage, being assaulted or raped [2, 3]. Here, we presented a middle-aged man who inserted a huge pesticide bottle in the rectum and its successful removal by an anal retractor under anesthesia.

This 51-year-old male patient visited the emergency department (ED) for abdominal pain with bloody stool passage after inserting a pesticide bottle into his anus 15 h prior to arrival to the ED by himself. He denied systemic disease but confessed having previous RFB removal history twice before this visit. No fever or shock sign was presented. Plain film revealed a 23 cm × 8 cm cylindrical foreign body in the lower abdomen (Fig. 1). Laboratory data showed borderline leukocytosis (10,100/μL). Hemoglobin, electrolytes renal, and liver function results were all within normal limits. Abdominal computed tomography disclosed retention of a large tubular foreign body in the rectosigmoid colon, without evidence of the pneumoperitoneum (Fig. 2). A proctologist was consulted for foreign-body removal. Under general anesthesia, an anal retractor was put into the anus, and a foreign body was seen. A large aluminum pesticide bottle was then removed successfully. Follow-up colonoscopy showed some ulcer and granulation polyps in the recto-sigmoid colon and lower rectum. The patient was hospitalized after surgical intervention with antibiotics treatment, moxifloxacin 400 mg daily. He was recovered to discharge 4 days later.

RFBs are more common in men than in women, with average cases presenting in middle age [4]. The mean time of ED visits from insertion was 23 h, with a range of 6–72 h [5]. Patients may be presented to the ED with lower abdominal or anorectal pain, with failure to remove foreign bodies after several attempts. Delay of ED visit may lead to mucosal edema or mucosal break with bleeding [6]. Digital rectal examination should be performed for assessing the anal-sphincter condition, rectal laceration, and bleeding status. Sometimes, the tip of foreign bodied could be touched by the finger. Abdominal palpation may evaluate the peritonitis possibility and detect rarely high-lying retained objects.

Most RFBs can be identified with plain radiography of the abdomen and pelvis. In more high-lying or nonradiolucent foreign bodies, computed tomography provides clearer relative location to the adjacent organs, with more clear evidence to rule out bowel perforation [6]. With the development of medical images, a 3D reconstruction image may depict a more visualized image to aid surgeons planning the management.

RFBs can be removed by a transanal approach but sometimes may require an abdominal approach. The transanal approach should be the first attempt if there are no signs of peritonitis and the foreign body is within 10 cm from the anal orifice [4]. Analgesia may be used to alleviate the pain during the transanal approach. In foreign bodies with a deeper location, endoscopy may aid the retrieval work. If transanal approaches fail or the patient has signs of bowel perforation, the abdominal approach with laparoscopy or laparotomy should be considered. Complications of RFB insertion include anal ulcerations, bleeding, abscess, and infection, with the most fearful condition being bowel perforation with peritonitis [7].

RFBs are a proctological emergency. Delayed treatment may lead to high risk of complications. Doctors should educate the patient to seek medical help promptly after failing to remove the foreign bodies in several attempts. A better image leads to more precise decisions for management. With advance in imaging technology, we can use more examining tools in more complicated cases to promote management planning.

Published research complies with internationally accepted standards for research practice and reporting in line with COPE guidelines. In case report or retrospective chart review with three (3) or fewer (an n < 3) patients not presented as a systematic investigation designed to contribute to generalizable knowledge, IRB approval is not required. Written informed consent for publication of the case was obtained and signed by the patient to publish the case and the images.

No conflict of interest to declare.

None.

Chia-Chieh Ho performed data gathering and writing; Yu-Jang Su revised and corresponded.

All data generated during this case report are included in this article. Further inquiries can be directed to the corresponding author.