Endoscopic removal of a large rectal foreign body using a large balloon dilator: report of a case and description of the technique

Retained rectal foreign bodies are commonly encountered, and various shapes and sizes have been described. Although many foreign bodies can be extracted safely, some patients require hospitalization and surgery [1] [2] [3].

We report the case of a 54-year-old, symptom-free man who was admitted to the emergency department for a retained large rectal vibrator, which had been inserted in a reverse fashion during sexual activity. An abdominal radiograph showed a well-delineated vibrator (length 21 cm; diameter 35 mm) in the rectosigmoid junction with no evidence of bowel perforation ([Fig. 1]). After several unsuccessful transanal attempts to remove the foreign body, the patient was referred to the digestive endoscopy unit. Under deep sedation, a 13-mm endoscope (ES-250WE5, Fujinon Inc., Saitama, Japan) was inserted, which showed the blunt distal tip of the vibrator ([Fig. 2]). However, all attempts to ensnare it with a variety of polypectomy snares, and an inflated wire-guided 20-mm balloon dilator (CRE; Microvasive, Boston Scientific, Massachusetts, USA) to gently pull out the foreign body, were ineffective. After substituting the endoscope with another with a diameter of 10 mm (EG-201FP; Fujinon, Inc., Saitama, Japan), in order to reach beyond the proximal tip of the vibrator, a guide wire, under endoscopic view, was inserted over the foreign body. Then the scope was removed and a 40-mm balloon dilator (Rigiflex; Microvasive, Boston Scientific, Massachusetts, USA) was inserted over the wire. The balloon was inflated and gently retracted while guiding the distal tip of the vibrator with a finger to successfully retrieve it. A check sigmoidoscopy after extraction showed a large superficial mucosa injury, however, the patient was discharged 48 hours later without clinical evidence of complications.

Fig. 1 Radiographic view the vibrator inserted in the reverse position.

Fig. 2 Endoscopic view of the tip of the vibrator.

To the best of our knowledge, this report is the first to describe the removal of a large, smooth foreign body from the rectum using a 40-mm, large balloon dilator.

Competing interests: None

Endoscopy_UCTN_Code_TTT_1AQ_2AH

References

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• 2 Rodríguez-Hermosa J I, Codina-Cazador A, Ruiz B. et al . Management of foreign bodies in the rectum.  Colorectal Dis. 2006;  9 543-548
• 3 Goldberg J E, Steele S R. Rectal foreign bodies.  Surg Clin North Am. 2010;  90 173-184