Korean J Gastroenterol.  2020 Jul;76(1):42-45. 10.4166/kjg.2020.76.1.42.

Endoscopy-assisted Removal of a Large Rectal Foreign Body by the Valsalva Maneuver

• Son MY
• Park SJ
• Moon W
• Oh GM
• Park MI
• Kim SE
• Kim JH
• Jung K

• KMID: 2504593
• DOI: http://doi.org/10.4166/kjg.2020.76.1.42

Abstract

Although not as common as foreign bodies in the upper gastrointestinal tract, rectal foreign body insertion is often encountered in emergency departments. The diverse types of rectal foreign bodies have led to various removal methods. When removing a foreign body, the first thing to consider is which method is the least invasive and safest for the patient. This paper reports the successful removal of a rectal foreign body from the rectum using the Valsalva maneuver without anesthesia in a patient.

Keyword

Rectum; Foreign bodies; Valsalva maneuver; Endoscopy

Figure

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  Fig. 1 Plain abdominal radiograph revealed a huge, oval object lying longitudinally in the rectosigmoid region.

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  Fig. 2 Endoscopy demonstrated a large foreign body embedded tightly, just proximal to the middle rectal fold.

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  Fig. 3 Tenaculum forceps (23.0 cm, straight) (A) was inserted into the distal rectum under endoscopy, and (B) the rectal foreign body was grasped successfully with the hooks of the tenaculum forceps under endoscopy.

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  Fig. 4 Foreign body (A) removed successfully from the distal rectum measuring 17×6×3 cm with a capacity of 520 mL. (B) An endoscopic image obtained after extracting the rectal foreign body showed multiple linear shallow active ulcers with diffuse edematous mucosa and 10 cm to 25 cm in size from the anal verge.

Reference

1. Kurer MA, Davey C, Khan S, Chintapatla S. 2010; Colorectal foreign bodies:a systematic review. Colorectal Dis. 12:851–861. DOI: 10.1111/j.1463-1318.2009.02109.x. PMID: 19895597.

2. Cologne KG, Ault GT. 2012; Rectal foreign bodies: what is the current standard? Clin Colon Rectal Surg. 25:214–218. DOI: 10.1055/s-0032-1329392. PMID: 24294123. PMCID: PMC3577617.

3. Coskun A, Erkan N, Yakan S, Yıldirim M, Cengiz F. 2013; Management of rectal foreign bodies. World J Emerg Surg. 8:11. DOI: 10.1186/1749-7922-8-11. PMID: 23497492. PMCID: PMC3601006.

4. Mikami H, Ishimura N, Oka A, et al. 2016; Successful transanal removal of a rectal foreign body by abdominal compression under endoscopic and x-ray fluoroscopic observation: a case report. Case Rep Gastroenterol. 10:646–652. DOI: 10.1159/000452210. PMID: 27920656. PMCID: PMC5126614.

5. Sei H, Tomita T, Nakai K, et al. 2018; Rectal foreign body of eggplant treated successfully by endoscopic transanal removal. Case Rep Gastroenterol. 12:189–193. DOI: 10.1159/000488974. PMID: 29805365. PMCID: PMC5968260.

6. Koornstra JJ, Weersma RK. 2008; Management of rectal foreign bodies:description of a new technique and clinical practice guidelines. World J Gastroenterol. 14:4403–4406. DOI: 10.3748/wjg.14.4403. PMID: 18666334. PMCID: PMC2731197.

7. Goldberg JE, Steele SR. 2010; Rectal foreign bodies. Surg Clin North Am. 90:173–184. DOI: 10.1016/j.suc.2009.10.004. PMID: 20109641.

8. Lim KJ, Kim JS, Kim BG, et al. 2015; Removal of rectal foreign bodies using tenaculum forceps under endoscopic assistance. Intest Res. 13:355–359. DOI: 10.5217/ir.2015.13.4.355. PMID: 26576143. PMCID: PMC4641864.

9. Palit S, Lunniss PJ, Scott SM. 2012; The Physiology of Human Defecation. Dig Dis Sci. 57:1445–1464. DOI: 10.1007/s10620-012-2071-1. PMID: 22367113.

10. Nemoto D, Hayashi Y, Utano K, et al. 2016; A novel retrieval technique for large colorectal tumors resected by endoscopic submucosal dissection: tumor extraction by defecation. Endosc Int Open. 4:E93–E95. DOI: 10.1055/s-0041-107902. PMID: 26793792. PMCID: PMC4713179.