Anal Eroticism: Two Unusual Rectal Foreign Bodies and Their Removal
by Drs. Roy W. Graves, E. Jackson Allison, Jr., Robert R. Bass, and Richard C. Hunt
from Southern Medical Journal --
FOREIGN BODIES in the colon and rectum are
frequently encountered in busy emergency departments. They are almost
always self-administered by male patients. To initiate a discussion of
the clinical entity of anal sexual eroticism, we present two cases, that
of an elderly male patient with a peanut butter jar lodged in his rectum,
and a younger man who had a large plastic vibrator on his rectal shelf.
CASE REPORTS Case 1. A 65-year-old man came to the emergency
department of an outlying hospital complaining of lower abdominal pain.
A large empty glass jar was discovered in the rectum, and the patient
was transferred to the regional medical center for its extraction. The patient
reported that he was washing his dog in the shower when he slipped and
fell on a glass jar, which entered his rectum. Physical and radiologic
examinations showed an inverted glass jar, 8 cm in diameter, located just
beyond the anal sphincter. The glass was intact and there was no apparent
bleeding. After multiple unsuccessful attempts at removal in the emergency
department, the patient was taken to the operating room, given spinal anesthesia,
and placed in the jack-knife position; the anal region was prepped and
the buttocks separated with tape. Through a Robinson catheter, introduced
beyond the exterior of the jar, air was insufflated to break the partial
vacuum behind the jar. Then, with the patient in the deep Trendelenburg
position, the jar was filled with quick-setting two-inch plaster rolls
packed around an Army-Navy right-angle retractor and allowed to set. After
approximately 15 minutes, the anal sphincter was retracted with right-angle
vaginal retractors and gentle finger pressure was used to massage the edematous
tissue over the leading edge of the jar as it was rotated gradually and
delivered. Examination of the distal sigmoid, rectum, and anus showed
only edema, ecchymoses, and minor abrasions. The patient recovered fully
after the procedure and was discharged from the hospital the following
Case 2. A 34-year-old man came to the emergency
department one evening complaining of rectal and lower abdominal pain after
allegedly having been abducted and sexually assaulted by several other
men. Abdominal examination revealed a firm mass above the umbilicus, and
digital palpation rectally encountered a hard, plastic object at 4 or 5
cm. A roentgenogram showed a large vibrator in the rectum. No free air
was detected under the diaphragm, and bowel sounds and vital signs were
When repeated attempts to extract the vibrator were unsuccessful, the
patient was admitted to the hospital, given nothing by mouth, and the next
morning was taken to the operating room, where the plastic foreign body
was extracted without complication, with the patient under spinal anesthesia.
He was observed for 24 hours and discharged. Subsequent police investigation
determined that no abduction had occurred, and that the vibrator had most
likely been self-administered.
DISCUSSIONIn one review of colorectal foreign bodies and their management, all
patients were male and mostly in the fourth and fifth decades of life.
Most often the foreign bodies had been self-introduced. All patients
had physical examination, biplane abdominal roentgenograms, and proctosigmoidoscopy
to determine location, type, and number of foreign bodies. Transanal manipulation
and extraction of the foreign bodies were attempted only after regional
anesthesia. After removal, a repeat proctosigmoidoscopic examination was
done to assess the condition of the bowel wall, and the patients were then
observed for 24 hours for possible complications. Sohn and Weinstein reported
more than 100 cases of successful removal of foreign objects in the office,
with local, perianal, and submucosal anesthesia. Althought perforation of the bowel
wall is not common, one series reported five perforations associated with
28 colorectal foreign bodies.
Over the years, a multitude of objects have been removed from the colorectal
area, including bottles, candles, fruits, vegetables, vibrators, tumblers,
a polyethylene waste trap from the U-bend of a sink, salami, sponge rubber
balls, baseballs, sewing needles, marijuana, sandfilled bicycle inner tubing,
an aluminum tube (used by a prisoner to store money and other valuables),
broomsticks, and glass tubes.
Eftaiha and his colleagues outlined the princible of management of
colorectal foreign bodies and provided helpful methods of extraction, including
the use of Foley catheters with inflated balloons for traction, plaster
of Paris in glass containers (first reported in 1949 by Bacon), and obstetric
instruments to aid in delivering the objects...
There are reports in the literature of colorectal foreign bodies having
been in place for months and even years without perforation or other significant
complications. The use of enemas and catheters to aid in removal continues
to be somewhat controversial.
SUMMARYWe have described two cases involving unusual rectal foreign bodies
and their subsequent removal. Suggestions are included to aid in the removal
of colorectal foreign bodies, as well as references to provide for the appropriate
management of these cases in the emergency department.
Primary care providers need to be aware of the issue of colorectal
foreign bodies as a clinical entity and the fact that their occurrence
is expected to continue to rise dramatically. Patient education of the
dangers inherent in the insertion of objects into the colorectal area should
be more prevalent. At the very least, all physicians need to be aware
of anal eroticism and the necessity to take a careful medical history.
Acknowledgments. We thank Jo Bass and Doris Vincent
for preparation of this manuscript.
Thanks to Mark Slater who plucked
this gem from the research lib and snailmailed it to me.
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