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academies
International Surgery and Ortho Conference
October 25-26, 2017 | Toronto, Canada
Case Rep Surg Invasive Proced 2017 | Volume 1 Issue 3
Case of glass bottle in the rectum and management algorithm
Vikram Saini
MAMC, India
C
ase report begins with a 36-year-old male presented
with the history of accidental introduction of glass bottle
in the rectum. Multiple repeated attempts of self-removal
failed at home and Civil Hospital Fatehabad and patient refer
to MAMC, Agroha. Vital signs normal abdomen was soft with
hard moving object felt suprapubic region. X-ray of abdomen
shows the glass bottle. Per rectal examination performed
after the X-ray of the abdomen revealed the base of the
glass bottle. Manual removal by holding the base was not
successful due to mucous coating the surface. All methods
of removal in different position and with obstetrics forceps,
vacuum suction tried in emergency room but failed. Patient
shifted to Operation Theater and under general anesthesia
glass bottle of length 16 cm was taken out by transanal
route. Glass bottle having some suspicious matter in it
appear to be case of smuggling some narcotic substance,
object was sealed and handed over to police. Patient did not
reveal anything new in history and repeatedly telling it was
an accident of falling on a bottle while he was defecating
outside in open field. Post removal per rectal examination
and sigmoidoscopy did not reveal any colorectal injury
except some minor anal tears. Post removal recovery was
uneventful and patient did not have anal incontinence or
perianal infection. Psychiatric opinion was taken and patient
was discharged after informing police.
Discussion:
Males are commonly affected. Most of case
series of foreign body within the rectum are reported from
Eastern Europe and uncommon in Asia. The object length
varied between 6 and 16 cm, and larger objects were more
prone for complications. Per rectal examination is the
cornerstone in the diagnosis, but it should be performed
after X-ray abdomen to prevent accidental injury to the
surgeon from sharp objects. X-ray pelvis and X-ray abdomen
help in locating and localizing the foreign body and rule out
intestinal perforation. The lateral films of pelvis will orient
whether the foreign body is high or low lying. Majority (90%)
of the cases is treated by transanal retrieval. Abdominal
manipulation and stabilization helps in retrieval when the
bottle is slippery. Obstetric forceps or snares are only helpful
in grasping the broad and slippery base with limited success.
Colonoscopy removal is also reported with good success.
Even with laparotomy, the aim is transanal removal and
closure of perforation with diversion colostomy.
Conclusion:
In the present case, 16 cm large glass bottle
transanal removal was carried out under general anesthesia
without any complication. Abdominal manipulation
and stabilization helps in retrieval the bottle by relaxing
abdominal and rectal muscle under general anesthesia.
Speaker Biography
Vikram Saini completed his MBBS from PGIMS Rohtak Haryana India. He joined MAMC
Agroha India for Post-graduation in Surgery and he is currently working there. During
this time period, he co-authored “Evaluation of the Epidemiological and Clinical Profile
of Patients with Traumatic Brain Injury in a Rural Medical Institution: A Retrospective
Study” in J Adv Med Dent Scie Res. And he also presented a poster at PGIMS Rohtak,
Haryana Chapter ASI.
e:
vikramsaini2006@hotmail.com