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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 549-551
Sonographic diagnosis of a glass foreign body in the rectum


Department of Radiology, Seth GS Medical College and K.E.M Hospital, Acharya Donde Marg, Parel, Mumbai-400012, India

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Date of Submission13-May-2006
Date of Acceptance10-Aug-2006
 

Keywords: Sonography, Rectum, Foreign body, Glass

How to cite this article:
Sarai R K, Khandelwal A P, Morani A C, Ashtekar J L. Sonographic diagnosis of a glass foreign body in the rectum. Indian J Radiol Imaging 2006;16:549-51

How to cite this URL:
Sarai R K, Khandelwal A P, Morani A C, Ashtekar J L. Sonographic diagnosis of a glass foreign body in the rectum. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 24];16:549-51. Available from: http://www.ijri.org/text.asp?2006/16/4/549/32266

   Introduction Top


There are numerous reports of foreign body in the rectum .To the best of our knowledge there is no report describing the sonographic diagnosis of a glass foreign body in the rectum. The rectum, vagina, urethra, nose and ear are favorite sites for insertion of the foreign bodies. These types of insertions are most frequently seen in children but adult patients may derive sexual pleasure from it [1]. We present the characteristic sonographic features of a glass foreign body with a phantom study.


   Case report Top


A forty eight year old man presented in the emergency department with pain in abdomen since 4 hours .The abdominal examination was unremarkable.

An ultrasound of the abdomen was advised. Patient was in agony and was not able to hold urine. The ultrasound revealed a 8 X 4 cm long hyperechoic inverted ' L' shaped structure with posterior acoustic shadowing in the rectum in the longitudinal scan [Figure - 1] and curvilinear hyperechoic structure on the transverse scan [Figure - 2] in the rectum. The rest of the abdominal and pelvic ultrasound was unremarkable. These ultrasound findings raised a suspicion of a foreign body in the rectum. Frontal and lateral [Figure - 3] radiographs of the pelvis were obtained, which confirmed our suspicion. On further questioning patient gave the history of insertion of a tea glass in the rectum, few hours back .He also had a prior history of insertion of foreign body in the rectum. A limited plain CT scan [Figure - 4] through the rectum was done to look for the associated complications. CT scan showed the foreign body to be in the rectum. No evidence of bowel perforation was found. As the foreign body could not be manually or endoscopically removed per rectally under general anaesthesia, rectotomy with proximal diverting loop sigmoidostomy was done. [Figure - 6]

In vitro sonography of the glass was performed which revealed reverberation artifact and posterior acoustic shadowing. [Figure - 5]


   Discussion Top


Foreign body insertions are common in children (especially with emotional problems), mentally retarded or incapacitated individuals, adults engaging in unusual sexual practices, patients undergoing instrumentation or surgery and patients undergoing non-traditional medical therapy. [1]

Surprisingly, most of the foreign bodies inserted into the rectum or urethra do not cause significant injury even if they are large, sharp, or pointed. These structures are capable of considerable expansion, and they are well lubricated by natural fluids. Patients also learn how to dilate these structures so that they will accommodate large objects.

Embarrassment and fear of humiliation may explain the frequent reports of patients admitted with rectal foreign bodies who give vague and nonspecific history. It often results in delayed diagnosis and treatment and so, the increased risk of complications. [2]

Small, retained rectal foreign bodies usually pass spontaneously. Large ones may lead to enough wall edema or bowel atony, so that they may not be passed naturally. Retained rectal bodies may rarely form asymptomatic calcified fecoliths. More commonly, they cause acute and/or chronic discomfort. They can cause severe bleeding, bowel obstruction and perforation or even ascend higher into the colon and lead to local complications there. If they perforate the colon, they may lodge in the retroperitoneal tissues, induce localized contained abscesses or lie free within the peritoneum [1].

On radiographs, all the glass found on motor vehicles and in the house is radio opaque and the degree of radio opacity depends on its relative density [3].

The degree of echogenicity of any foreign body is directly related to the acoustic impedance at its interface with the surrounding tissues. Metal and glass foreign bodies are visible on the radiographs. The exact location of a radio opaque foreign body, its relation to the surrounding structures, and the associated soft-tissue injuries can be further defined with US [1].

The artifact occurring deep to a foreign body depends primarily on its surface attributes rather than its composition. Smooth and flat surfaces usually cause dirty shadowing or reverberation artifacts behind while the irregular surfaces and those with a small radius of curvature lead to clean shadowing. Metal and glass, due to their flat surfaces, often produce reverberation. However, a flat surface, if not imaged perpendicular to the ultrasound beam, may not produce reverberation.

In vitro sonography of the glass, in our case, revealed the two surfaces of the glass with reverberation artifacts and acoustic shadowing of the anterior surface between the two. The bottom surface of the glass, being parallel (not perpendicular) to the US beam, was not well visualized [5].

Numerous ingenious approaches have been devised to remove these foreign objects [6].

It can be removed manually, endoscopically after adequate anal sphincter relaxation; by perianal extraction with the patient under anesthesia [1]. In patients with overt peritonitis or pelvic sepsis that results from perforation of the bowel, the large size foreign bodies or bodies with broken sharp edge toward the anus or when it can not be removed endoscopically, as in our case, exploration may be necessary.

In conclusion, in cases of vague abdominal features, one must remain aware of the rectal foreign body to avoid delay in the diagnosis and its complications [6]. US can be used effectively to locate it and assess the surrounding soft tissue complications. The characteristic sonographic features of the glass foreign body can only be seen, if its surface is perpendicular to the US beam.

 
   References Top

1.Tim B, Hunter and Mihra S, Taljanovic, Foreign bodies. Radiographics 2003; 23: 731-757.  Back to cited text no. 1    
2.Bush DB, Starling JR, Rectal foreign bodies: case reports and a comprehensive review of the world's literature. Surgery 1986; 100: 512-9.  Back to cited text no. 2    
3.Tedric DB, David PF, Jon AJ, John L, Marnix TVH, Curtis WH, US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics 2001; 21: 1251-1256.  Back to cited text no. 3    
4.Lacey G, Evans R and Sandin B, Penetrating injuries: how easy it is to see glass (and plastic) on radiographs? . British J of Radiol 1985; 58: 27-30.  Back to cited text no. 4    
5.Lazar J and Asrani A. Sonographic diagnosis of a glass foreign body in the urinary bladder. J Ultrasound Med 2004; 23: 969-971  Back to cited text no. 5    
6.Huang WC, Jiang JK, Wang HS, Yang SH, Chen WS, Lin TC, Retained rectal foreign bodies. J Chin Med Assoc. 2003; 66: 607-612.  Back to cited text no. 6  [PUBMED]  

Top
Correspondence Address:
A C Morani
Department of Radiology , Seth GS Medical College and K.E.M Hospital, Parel, Mumbai-400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32266

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]

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2 Foreign bodies in the rectum: A report on three cases including a bullhorn in the rectum
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[Pubmed] | [DOI]



 

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