Retained Colorectal Foreign Body After Suspected Chemical Incapacitation: A Surgical and Forensic Challenge

Retained rectal foreign bodies are an uncommon but clinically significant surgical emergency. We report the case of a 74-year-old male with multiple medical comorbidities who presented with progressive rectal pain and obstipation several days after an episode of suspected drug-facilitated assault. Plain radiography identified a large metallic aerosol can, and attempts to retrieve it under general anesthesia using surgical clamps and a magnetic probe failed. Intraoperative fluoroscopy demonstrated that the can had migrated proximal to the rectosigmoid junction into the left colon, precluding transanal extraction. The patient underwent exploratory laparotomy with longitudinal colotomy, permitting safe removal of the foreign body without evidence of perforation or visceral injury. This case illustrates the critical role of intraoperative fluoroscopy when digital examination fails, the indications for operative intervention in proximally migrated foreign bodies, and the importance of considering drug-facilitated assault as an etiology.