1978 Picking up the Pieces: Surgical and Medical Management of Retained Shattered Glass in the Rectum

Abstract

INTRODUCTION: Retained rectal foreign bodies are an increasingly common presentation requiring emergent surgery. The object can often be retrieved at bedside. However, in the setting of a retained foreign body, especially one complicated by bleeding, perforation, or peritonitis, open surgery or laparoscopic assisted transanal retrieval is often needed. Careful investigation and a high index of suspicion is required as patients are often reluctant to share the etiology of their presentations. CASE DESCRIPTION/METHODS: A 55-year-old male presented to the ED with complaints of rectal bleeding. He stated he had placed a glass bottle in his rectum. Upon removal he noticed the top half of the bottle was retained inside his rectum. He developed mild rectal pain and bright red blood per rectum. On exam, there were no peritoneal signs. DRE revealed no perianal lesions, sphincter lacerations, or palpable foreign bodies. Initial labs displayed hemoglobin and hematocrit at 11.7 and 34.1, respectively. CT showed multiple radiopaque foreign bodies in the distal rectosigmoid measuring up to 14 cm in length with presacral edema. Proctoscopy was performed in the OR. Glass which was readily removable via a transanal approach was retrieved, while larger perforating pieces were carefully mobilized proximally and retracted via laparotomy. Sigmoidoscopy confirmed complete removal with multiple deep lacerations and perforations in the rectal wall. On post-op day seven, large volume rectal and mucus fistula bleeding with severe hypotension, tachycardia, change in mental status and a drop in hemoglobin to 5.8 occured. MTP was activated with administration of a total of five units of PRBC and two units of FFP. Colonoscopy was performed in the OR. An ulcer containing a pulsating, protruding, visible vessel was actively bleeding. Two clips were placed over the vessel with no further episodes of bleeding. Three months postoperatively barium enema was performed showing no leaks leading to reversal of colostomy. DISCUSSION: A retained rectal foreign body is not commonly the cause of a surgical emergency. Post-op complications, such as rectal bleeding, are rare and are normally handled by a return to the OR to control the source. Colonoscopy after a perforating rectal injury may be considered to evaluate and stop the source of postoperative bleeding, thus avoiding additional surgery and decreasing recovery time. Additionally, DRE should be cautioned when suspecting sharp hazardous material at an undetermined height in the colorectal tract.