Aimanan Karthigesu, Lim Soon Yee, Ahmad Hamidi Ahmad Junaidi, Chieng Tiong How, Hayati Firdaus
Department of Surgery, Miri Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia.
Department of Surgery, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia.
Front Surg. 2022 Jun 10;9:921843. doi: 10.3389/fsurg.2022.921843. eCollection 2022.
Rectal foreign bodies often constitute an arduous diagnosis and perplexing management. A 72-year-old gentleman who is mentally sound was brought to the emergency department for severe epigastric pain of a 1-week duration. On examination, he was pyrexial and in sepsis. The abdomen was guarded. A digital rectal examination was normal. Erect chest radiography revealed air under the diaphragm and abdominal radiography showed neither dilated bowel nor foreign body. A diagnostic laparoscopy was performed which revealed a yellow hard rod-shaped foreign body at the pelvis. Upon conversion to midline laparotomy, the foreign body was found to be a toothbrush with intraperitoneal rectal perforation of 1 cm in length. The brush was removed and the perforation was repaired primarily. A diverting transverse loop colostomy was created. Rectal foreign bodies may cause life-threatening rectal injuries including lacerations, bleeding, perforation, and obstruction. It is deemed crucial that any patient with rectal foreign body demands an orderly approach with the intention of diagnosis, management, and post-extraction evaluation.
直肠异物的诊断往往困难重重，处理起来也令人困惑。一名72岁精神状态良好的男性因持续1周的严重上腹部疼痛被送往急诊科。检查时，他发热且处于脓毒症状态。腹部有压痛。直肠指检正常。立位胸部X线片显示膈下游离气体，腹部X线片未显示肠管扩张或异物。进行了诊断性腹腔镜检查，发现盆腔有一个黄色硬棒状异物。转为中线剖腹手术后，发现异物是一把牙刷，直肠有1厘米长的腹腔内穿孔。取出牙刷并对穿孔进行了一期修复。做了一个转流性横结肠袢式造口术。直肠异物可能导致危及生命的直肠损伤，包括撕裂伤、出血、穿孔和梗阻。对于任何直肠异物患者，采取有序的方法进行诊断、处理和取出后评估至关重要。
