REMOVAL OF LARGE CYLINDRICAL FOREIGN BODY IN HIGH RECTUM WITHOUT ANESTHESIA OR SEDATION.
38 yrs old male presented with complaints of foreign body (aerosol spray cannister of body deodorant with cap 16 cms long and 3 ½ cms diameter cylindrical shape) insertion for auto eroticism of 2 hrs duration with pain in lower abdomen and inability to extract the same. P/R examination did not feel any mass in rectum. X- Ray abdomen revealed large radio opaque shadow lying in midline over lower lumbar vertebrae. In view of cylindrical shape with cap in place and high placement from anal canal consent was taken for removal under general anesthesia. However before proceeding with the anesthesia routine flexile sigmoidoscopy was performed. The spray cannister cap was tried to be snared but appeared impacted into the rectosigmoid at 20 cms from anal verge. In view of difficulty in snaring the object gentle suction was applied below the object and the concious patient was urged to strain. This pushed the object down away from the wall it was lodged against. Snare could then be placed at junction of cap with body of the spray and gentle traction applied along with continuous urging to patient to strain till he delivered the object.
Most large foreign bodies impacted in high rectum require general anesthesia for adequate anal dilatation for manual extraction. Giving anesthesia takes away ability of patient to help by pushing the foriegn body. Pulling this type of cylindrical object held with a snare could not have delivered the object vertically. Combined gently traction with straining by concious patient achieved succesful outcome and avoided anesthesia. It was realised that more the insufflation that was being performed during sigmoidoscopy and attempt made to snare it, more it was being pushed up against the wall. Suction of rectal lumen helped dislodge it and concious patient could then push it into lower rectum.