Kim Ju Hun, Um Eunhae, Jung Sung Min, Shin Yong Chan, Jung Sung-Won, Kim Jae Il, Heo Tae Gil, Lee Myung Soo, Jun Heungman, Choi Pyong Wha
Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Ann Coloproctol. 2020 Oct;36(5):335-343. doi: 10.3393/ac.2019.10.03.1. Epub 2020 Jan 31.
Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.
We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.
All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.
Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.
由于将异物插入肛门被视为一种禁忌行为，直肠内异物残留的患者可能会犹豫是否寻求医疗护理，而主治外科医生可能缺乏取出这些异物的经验。我们进行这项研究以评估韩国直肠内异物残留患者的临床特征，并根据我们的经验为此类病例提出管理指南。
我们回顾性调查了2006年1月至2018年12月期间的14例患者。我们评估了人口统计学特征、异物插入机制、诊断与处理之间的临床过程以及结果。
所有患者均为男性（平均年龄43岁），表现为下腹部疼痛（2例）、肛门出血（2例）或无症状但担心直肠内有异物残留（10例）。异物插入最常见与性满足或肛门色情有关（11例，78.6%）。除2例在急诊科取出异物外，所有患者均接受全身麻醉以使肛门括约肌松弛。通过使用夹子经肛门取出异物（2例）、肌瘤螺旋钻（1例）、腹壁压迫后应用夹子（2例）或剖腹手术继以直肠乙状结肠挤奶法（2例）。4例患者进行了结肠切开术和一期修复，1例粪便性腹膜炎患者进行了哈特曼手术。未报告有发病率或死亡率。所有患者均拒绝取出异物后的肛门直肠功能和解剖学评估以及心理咨询。
直肠内异物残留罕见；然而，结直肠外科医生应了解可用于取出异物的各种方法以及适用于此类病例的治疗算法。
