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Rectal Impaction Following Enema with Concrete Mix

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Rectal Impaction Following Enema with Concrete Mix

by Peter J. Stephens, M.D., and Mark L. Taff, M.D.
from the American Journal of Forensic Medicine and Pathology 8(2):179-182, 1987.

This article describes an unusual rectal foreign body resulting from homosexual anal erotic activities. The patient had used an enema containing a concrete mix which became impacted and required surgical removal. The use, abuse, and complications of enemas are reviewed.

Key Words: Anal eroticism--Colorectal injuries--Enemas, cement--Foreign bodies--Paraphilias.

During the last 20 years, sexual habits have changed in western society. Both homosexuals and heterosexuals have shown an increasing interest in anal erotic practices, including the use of enemas for sexual enjoyment. We report a case of a klismaphiliac who had an impacted foreign body in his rectum followin an enema with a concrete mix.

CASE REPORT

A 20-year-old man presented to the emergency room complaining of rectal pain. A well-nourished, well-developed man without signs of intoxication was admitted in no apparent distress. Digital examination of the rectum revealed a stony hard mass. Abdominal plain films showed a vertically oriented, low-lying radiopaque object in the rectum. A spherical radiolucency was noted in the upper pole of the mass. A blood alcohol level was negative. No other drug testing was performed.

Upon further questioning, the patient said that approximately 4 hrs earlier he and his boyfriend had been "fooling around." After stirring a batch of concrete mix, the patient laid on his back with his feet against the wall at a 45-degree angle while his boyfriend poured the mixture through a funnel into his rectum. After the concrete mass hardened, it became so painful that he sought medical care.

Under general anesthesia, the anus was dilated and two Foley catheters were inserted alongside the rectal mass to relieve suction. A concrete case of the rectum was delivered without incident. The rectal mucosa was intact with a hyperemic and edematous appearance.

The patient was kept overnight and discharged uneventfully the following morning. The attending physician recommended a psychiatric consultation, but the patient declined.

PATHOLOGIC EXAMINATION

Examination of the specimen revealed a perfect concrete cast of the rectum, measuring 12 X 7 X 5 cm and weighing 275 g

A thin layer of feces coated the surface and crevices. Grooves in the mass were consistent with rectal mucosal folds. A layer of concrete was chipped off the upper part of the specimen and revealed a white plastic ping-pong ball. This corresponded to the radiolucency observed in the abdominal x-ray.

http://www.well.com/~cynsa/cement.html

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- An unusual delivery LCD 19 y 82,918
  
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  An unusual delivery
  
  From: The British Journal of Hospital Medicine , 51(11), pg.615, 1994
  Submitted by: Fred Oliver, University of CT
  
  Sir,
  In an attempt to ease his constipation, a 64-year-old man had inserted a microwave egg boiler (MEB) into his rectum. This is an egg-shaped device -- 11 cm in diameter at its widest point -- with a rim at the base, and in two halves that can be joined firmly together. Unfortunately, the MEB rather exacerbated his constipation and he presented to us several hours later.
  
  Digital manipulation, bed rest and analgesia failed to relieve the problem and so he was listed for extraction of the MEB under general anaesthesia. He was placed in the lithotomy position and attmpts at manual extraciton were made. When these failed, two spong forceps and then two Blacks tissue forceps were attached to the rim at the MEB base; traction was applied combined with periabdominal pressure from the anaesthetist. This succeeded only in rotating the MEB about its longitudinal axis, partly as a result of its widest diameter being wedged above the ischial spines and partly because the base was impacting on the rectal valves.
  
  After a period of quiet contemplation, a pair of Wrigley's obstetric forceps were ordered from the labour ward. These were inserted around the egg as around the head of a baby, traction was applied along the pelvic curve and the MEB was 'delivered' with aplomb. Our patient suffered no further problems and indeed opened his bowels before discharge, his constipation cured.
  
  This is not the first use of obstetric forceps to remove rectal foreign bodies (MacDonald, 1961; Burre, 1969; Peet, 1976; Busch and Starling, 1986), but it illustrates the need for versatility among surgeons in the face of an ever-increasing array of modern-day obstacles.
  PJ Whatling
  Surgical Senior House Officer
  Department of Surgery
  MRW Stacey
  MSC Lecturer
  Department of Anaesthetics
  University Hospital of Wales
  Cardiff CF4 7EQ
  
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  - Foreign Bodies In The Rectum LCD 19 y 86,230 R Warning
    
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    FOREIGN BODIES IN THE RECTUM
    from Bailey & Love's Short Practice Of Surgery, 21st Edition (Chapman & Hall Medical, 1992) - pages 1219-1220.
    
    The variety of foreign bodies which have found their way into the rectum is hardly less remarkable than the ingenuity displayed in their removal (Fig. 52.7). A turnip has been delievered per anum by the use of obstetric forceps. A stick firmly impacted has been withdrawn by inserting a gimlet into its lower end. A tumbler, mouth looking downwards, has been extracted by filling the interior with a wet plaster of Paris bandage, leavin gthe end of the bandage protruding, and allowing the plaster to set. (O. Lloyd-Davies, 1905-87, Consultant Surgeon, St. Mark's Hospital, London)
    Fig. 52.7
    
    (a) A Pepper pot in the rectum. On removal it was found to be inscribed 'A present from Margate' (Dr. L.S. Carstairs, Royal Northern Hospital, London.)
    
    (b) A screwdriver with a plastic handle. (Dr. A.K. Sharma, Agra, India.)
    
    (c) A live shell, which needed careful handling.
    , which needed careful handling.
    
    If unsurmountable difficulty is experienced in grasping any foreign body in the rectum, a left lower laparotomy is necessary, which allows that object to be pushed from above into the assistant's fingers in the rectum. If there is considerable laceration of the mucosa a temporary colostomy is advisable.
    [many thanks to Dr. Kelvin Lau of Sydney, AU, for his research and scanning prowess...]
    
    From melanie Mon May 1 13:39:24 1995
    Subject: Live Artillery Shell
    
    I have a butt page story for you, but, unfortunately, no documentary evidence. The story was told me by my brother, who used to lodge with a nurse. It is the nurse's story. About five years ago an old WW2 veteran used to come into a hospital clinic in the east end of London suffering from bad haemorroids (piles). The clinic did what they could, but they could never relieve the most painful pile, which would hang down and get stuck on the seam of the man's underpants. To rid himself of the nuisance of this pile, the old man used to push it back up into his rectum using the artillery shell from an anti-aircraft gun he used to man in the war. One day the shell got stuck and the man was forced to hobble down to the hospital to get it removed. As the doctor was about to insert his fingers into the old man's rectum to remove the shell he said 'Of course, this shell is spent, isn't it?' 'Oh no,' said the old man 'There's enough ammo in that shell to blast a Messerschmidt (sp?) out of the sky.' So the doctor called in the army bomb squad, who built a lead box around the old man's %¤#&!§-and defused the shell in situ, before removing it.
    
    A good little story for VE day, I thought. --
    Melanie M.
    
    Read my messges on this board Read my messges anywhere
    
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