Treatment of unusual rectal foreign body using a Foley catheter

A 70-year-old man presented to our emergency department with a history of abdominal pain and bloating and lack of defecation for 3 days. A round, hard foreign body with a smooth surface was palpated on digital rectal examination. The man admitted having introduced a mandarin into the rectum 4 days previously. An attempt at manual extraction of the foreign body was unsuccessful. Endoscopic examination of the rectum showed that a round, orange-colored mandarin was almost completely obstructing the lumen, and did not allow the colonoscope (Pentax EC-380LKp, Tokyo, Japan) to pass to proximally beyond it ([Fig. 1]). Grasping the mandarin with a 50-mm polypectomy snare (Endo-Technik, Solingen, Germany) failed because of the mandarin’s round and smooth surface. A 14-French Foley catheter (PlusMed; Sisco Latex PVT, Chennai, India) was inserted and passed proximally to the mandarin under colonoscopic observation ([Fig. 2]). The balloon of the catheter was inflated with 20 mL water and pulled gently. In this way the mandarin was fully extracted without complication ([Fig. 3]). After the extraction, control endoscopic examination revealed only mild superficial laceration of the rectal mucosa. The patient was observed for a few hours after the procedure and discharged from the hospital on the same day.

Fig. 1 Endoscopic view of the mandarin in the rectum.

Fig. 2 The Foley catheter was inserted past the mandarin under endoscopic guidance.

Fig. 3 Extracted mandarin and Foley catheter next to a 20-mL syringe.

Most rectal foreign bodies have been inserted for sexual stimulation and are generally blunt, round, and have a smooth surface. Repetitive insertion of gradually larger objects makes these objects more difficult to remove [1]. Grasping round, large, smooth-surfaced objects is difficult with standard endoscopic devices [2] [3]. In such cases, using a Foley catheter in the treatment of rectal foreign bodies may allow a major surgical procedure to be avoided [4].

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• References

• 1 Fry RD. Anorectal trauma and foreign bodies. Surg Clin North Am 1994; 74: 1491-1505
• 2 Billi P, Bassi M, Ferrara F et al. Endoscopic removal of a large rectal foreign body using a large balloon dilator: report of a case and description of the technique. Endoscopy 2010; 42: E238
• 3 van der Wouden EJ, Westerveld BD. Extraction of a rectal foreign body using a custom-made giant snare. Endoscopy 2010; 42: E122
• 4 Humes D, Lobo DN. Removal of a rectal foreign body by using a Foley catheter passed through a rigid sigmoidoscope. Gastrointest Endosc 2005; 62: 610