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The things you find on the Web! I was innocently browsing in
a medical website (honestly!) when I followed an intriguing link,
and then another, and then…well, I ended up reading some strange tales.
It seems that casualty departments quite frequently have to extract
things from people's bottoms - so much so that there are well-rehearsed
procedures for dealing with such incidents.
Here are some of the more bizarre cases; others can be found on the side-panel. In the case notes themselves, place your cursor over the links to reveal explanations of the less well-known medical terms. |
Objects include:
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| An
Electric Light Bulb A 54-year-old man presented with the complaint that two days earlier he had drunk whiskey and "did something" to his rectum. He was obviously embarrassed and reluctant to explain his problem. Rectal examination revealed a hard, smooth, globular mass. When asked specifically, the patient admitted that an electric bulb had been in his rectum for two days. He said he had got drunk, accepted a wager of $100 and, using shaving cream as a lubricant, had inserted a 100-watt electric bulb into his rectum. The next day, sober, he realized that he had done a "stupid" thing but believed that the bulb would come out unassisted. After two days he became aware of difficulty defecating, and when he began to experience difficulty urinating, he became frightened and sought medical help. Films of the pelvis verified the location of the electric bulb, and the patient was taken to the operating room. He was placed in a face-down position with his hips elevated. The buttocks were separated and held apart by a circular metal ring. With the aid of malleable retractors in the rectum, the electric bulb was visualized, but it was not possible to get a gloved finger over the maximum diameter of the bulb. Toy darts with suction cup ends were used to draw the electric bulb to the sphincter. After drying the glass surface of the bulb with ethyl ether swabs, it was attempted to attach the suction cup end of the dart to the electric bulb with cyanoacrylate cement. Four attempts of this manoeuvre were unsuccessful: the cement would not stick. The patient was then turned to the lithotomy position and another dart was successfully attached to the bulb without any glue, and the bulb was pulled to the sphincter. Three #24 Foley catheters with 30-cc terminal balloons were lubricated with mineral oil and passed over the maximum diameter of the bulb. The catheters were placed at the six, ten and two o'clock positions. Throughout this procedure, a steady pull was maintained on the attached dart. After it was verified by digital examination that the tips and balloons of the catheters were beyond the maximum diameter of the bulb, the balloons were inflated with 30 cc of water, and about 30 cc of mineral oil was injected into the rectum through a Foley catheter. A steady pull of about five pounds was applied to each catheter, and after about ten minutes the sphincter began to dilate and the bulb began to emerge. The electric bulb finally came out through the external sphincter with no further complications. Sigmoidoscopic examination showed no bleeding or other injury to the rectal mucosa. After 24 hours of observation, the patient returned home. |
| A
Concrete Mix A 20-year-old man presented to the emergency room complaining of rectal pain. Digital examination of the rectum revealed a stony hard mass. Abdominal plain films showed a vertically oriented, low-lying radiopaque object in the rectum. A spherical radiolucency was noted in the upper pole of the mass. Upon further questioning, the patient said that approximately 4 hrs earlier he and his boyfriend had been "fooling around." After stirring a batch of concrete mix, the patient laid on his back with his feet against the wall at a 45-degree angle while his boyfriend poured the mixture through a funnel into his rectum. After the concrete mass hardened, it became so painful that he sought medical care. Under general anaesthesia, the anus was dilated and two Foley catheters were inserted alongside the rectal mass to relieve suction. A concrete case of the rectum was delivered without incident. The rectal mucosa was intact with a hyperaemic and oedematous appearance. The patient was kept overnight and discharged uneventfully the following morning. Pathologic Examination of the specimen revealed a perfect concrete cast of the rectum, measuring 12 X 7 X 5 cm and weighing 275 g (Fig. 2). A thin layer of faeces coated the surface and crevices. Grooves in the mass were consistent with rectal mucosal folds. A layer of concrete was chipped off the upper part of the specimen and revealed a white plastic ping-pong ball. This corresponded to the radiolucency observed in the abdominal x-ray. |
| Egg
Boiler: A Difficult Birth In an attempt to ease his constipation, a 64-year-old man had inserted a microwave egg boiler (MEB) into his rectum. Unfortunately, the MEB rather exacerbated his constipation and he presented to us several hours later. Digital manipulation, bed rest and analgesia failed to relieve the problem and so he was listed for extraction of the MEB under general anaesthesia. He was placed in the lithotomy position and attempts at manual extraction were made. When these failed, two Sponge forceps and then two Blacks tissue forceps were attached to the rim at the MEB base; traction was applied combined with periabdominal pressure from the anaesthetist. This succeeded only in rotating the MEB about its longitudinal axis, partly as a result of its widest diameter being wedged above the ischial spines and partly because the base was impacting on the rectal valves. After a period of quiet contemplation, a pair of Wrigley's obstetric forceps were ordered from the labour ward. These were inserted around the egg as around the head of a baby, traction was applied along the pelvic curve and the MEB was 'delivered' with aplomb. Our patient suffered no further problems and indeed opened his bowels before discharge, his constipation cured. |