doi:10.1111/j.1744-1633.2007.00376.

x Case report

Retrieval of rectal foreign bodies: A difficult case

Yue-Sun Cheung, John Wong, Wilson W.C. Ng, Tak-Lap Tam, Micah C.K. Chan and
Paul B.S. Lai*
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.

Foreign body in the rectum is not an uncommon condition encountered by general surgeons. Endoscopic
retrieval can be attempted but may not always be successful. A small proportion of patients require an
operation under general anaesthesia. There is no well-defined guideline for proper management of rectal
foreign body. We report a rare case (a 10-inch rectal vibrator) in which colonoscopic retrieval failed and,
subsequently, extraction under general anaesthesia was required. The literature was reviewed for an optimum
method of removal.

Key words: colonoscopy, colorectal surgery, foreign body, surgery.

Introduction Colonoscopy under sedation was attempted initially

Foreign body in the gastrointestinal (GI) tract is a
common problem encountered by general surgeons.
Endoscopy is a well-established diagnostic and thera-
peutic method for retrieval of foreign bodies in the
upper GI tract.1 For retained foreign bodies in the
colorectal region, the role of colonoscopic removal is
less well defined. We report a case of rectal foreign
body where colonoscopic retrieval failed and removal
under general anaesthesia (GA) was required.
Case report
A 48-year-old man was admitted 12 h after introduc-
tion of a 10-inch vibrator into his rectum. He com-
plained of lower abdominal pain with a small amount of
per-rectal bleeding on admission. His vital signs were
stable and abdominal examination did not reveal any
peritonism or palpable mass. Digital rectal examina-
tion revealed a hard cylindrical object with a smooth
circular base impinging onto the posterior wall of the
rectum about 8 cm from the anal verge. Anal tone was
laxed. Third-degree haemorrhoids were also noted.
Abdominal radiograph showed an opacity corre-
sponding to the battery unit of the vibrator (Fig. 1).
There were no dilated bowels to suggest intestinal
obstruction and there was no evidence of bowel per-
foration. His haemoglobin level was normal, and there
was no leucocytosis.
*Author to whom all correspondence should be addressed.
Email: paullai@cuhk.edu.hk
Received 13 June 2006; accepted 3 November 2006.
for retrieval of the vibrator (Fig. 2). Various types of
snares and forceps were used to try to catch the distal
end of the vibrator. However, none of them were able
to achieve an engagement tight enough for removal.
Subsequently, the patient was put in the lithotomy
position in the operating theatre under general anaes-
thesia. With adequate muscle relaxation, the proximal
part of the foreign body could be felt around the
umbilical region. Through the anus, the distal end was
grasped with a pair of sponge-holding forceps and
trans-anal removal was successful with some assis-
tance of trans-abdominal pressure. The foreign body
was a 10-inch cylindrical vibrator made of hard rubber
(Figs 3,4). No colonic damage was noted on sigmoi-
doscopy. The patient was discharged 2 days after-
wards with no specific complaints.
Discussion
Foreign body in the rectum can be caused by anal
eroticism, concealment of illegal drugs, attention-
seeking behaviour, assault, accident and occasionally
retained ingested foreign bodies.2,3 A host of different
foreign bodies with various sizes and shapes have
been described, including glass bottles, aerosol cans,
light bulbs, corn cobs, vibrators, hosepipes, primus
stoves, and packets of marijuana.2–4 It can be diag-
nosed by history, physical examination (mainly by
digital rectal examination) and confirmed by plain
abdominal radiographs. The condition can be classi-
fied according to the level with respect to the rectosig-
moid junction. Low-lying foreign bodies are those

Surgical Practice (2007) 11, 162–164 © 2007 The Authors

Journal compilation © 2007 College of Surgeons of Hong Kong
 Retrieval of rectal foreign bodies
Fig. 1. Abdominal radiograph showing the battery unit of the
vibrator. The outline of the entire vibrator can actually be seen on
careful examination. There was no evidence of intestinal
obstruction or perforation.
Fig. 2. Colonoscopic view of the bottom end of the vibrator
located 8 cm from the anal verge.
located inside the rectal ampulla, whereas high-lying
foreign bodies lie at or above the rectosigmoid
junction.2–4 This classification has been used as a
general rule to guide the method of retrieval.4,5
For uncomplicated low-lying foreign bodies, transa-
nal extraction can be achieved by digital manipulation
or using various grasping forceps through proctos-
copy, anal retractor or rigid sigmoidoscopy. If vacuum
is built up proximal to the foreign body preventing its
extraction, a Foley catheter could be passed proximal
to it to overcome the negative pressure.4 As anal
spasm can hold the foreign body away from anus,
adequate relaxation is often needed. In difficult
Surgical Practice (2007) 11, 162–164 © 2007 The Authors
Journal compilation © 2007 College of Surgeons of Hong Kong
163
Fig. 3. Vibrator.
Fig. 4. Circular base of the vibrator.
cases, extraction may require complete relaxation of
anal sphincters by local, regional or even general
anaesthesia.2,4
For high-lying foreign bodies, trans-anal extraction
can still be successful, but they are more likely to
require a GA. In a review by Lake et al.5 consisting of
87 patients, the level of the foreign body was the only
significant predictor of failed bedside removal. Foreign
bodies located in the sigmoid region were 2.25-fold
(1.1–4.4, 95% confidence interval) more likely than
those located in the rectum to require removal under
GA. Seventeen out of 23 patients (74%) in the anaes-
thetic group could be managed without laparotomy. In
the remaining eight patients, five required a colotomy,
two patients had a repair of the perforation and only
one foreign body could be extracted trans-anally.
For patients presenting with frank peritonitis, laparo-
tomy is mandatory to remove the foreign body, repair
164 YS Cheung et al.
the perforation and perform surgical lavage. A divert-
ing stoma may sometimes be needed.
In the present case, removal by colonoscopy under
sedation was not successful as the patient was not
fully relaxed and no endoscopic instrument was able
to grasp the vibrator tightly enough. It was only under
GA that we could pass a strong grasping forceps
through the anus. Although there are reports using
colonoscopy to remove rectal foreign bodies, one may
find that the endoscope itself may actually displace
the foreign body more proximally making removal
even more difficult.6
In a case report by Ahmed and Cummings,7 the
foreign body had an eye-hook at the bottom end, such
that an endoscopic guidewire could be passed
though the eye to hold the object for extraction. In light
of this case, it might be advisable for the designer of
rectal vibrators to incorporate an eye-hook at the
bottom end, so that even if it was accidentally inserted
too deeply into the rectum, trans-anal removal could
be achieved slightly more easily.
In conclusion, rectal foreign bodies should be
managed in a well-organized manner. Most of them
can be removed trans-anally without a laparotomy.
However, the surgeons should always be prepared for
retrieval under GA in the operating room. Informed
Surgical Practice (2007) 11, 162–164 © 2007 The Authors
Journal compilation © 2007 College of Surgeons of Hong Kong
consent should at least include a possible laparotomy
and a stoma. A ‘push-and-pull’ two-hand technique
may facilitate retrieval if the foreign body has migrated
intra-abdominally. Commercially available vibrators
could be been better designed (e.g. with an eye-hook
at the bottom end) in order to facilitate retrieval in
cases of over penetration.
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