Repeat presentation of large rectal foreign body requiring surgical intervention

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Emergency Medicine

Background:

• Rectal foreign bodies (RFBs) present a unique challenge in emergency medicine.
• While trans-anal removal is feasible for smaller objects, larger or impacted RFBs often require surgical intervention.
• Previous abdominal surgery can complicate management due to adhesions and tissue inflammation.

Observation:

• A 57-year-old male presented with a large rubber chew toy (11x10 cm) lodged in the rectosigmoid.
• The patient had a history of a previous laparotomy for a baseball lodged in the same location one year prior.
• Exploratory laparotomy revealed significant bowel edema, inflammation, and extensive adhesions from prior surgery.

Findings:

• The large size and impacted nature of the chew toy, coupled with severe adhesions, precluded less invasive removal.
• A Hartmann's procedure was performed for successful removal of the foreign body.
• The patient's complex presentation underscores the challenges associated with recurrent and large rectal foreign bodies.

Implications:

• This case emphasizes the need for a multidisciplinary approach in managing complex rectal foreign bodies.
• Surgical intervention, including procedures like Hartmann's, may be necessary for large or impacted RFBs, especially in patients with prior abdominal surgery.
• Referral to mental health professionals is crucial for addressing underlying behavioral issues contributing to recurrent foreign body impaction.