A 52 year old male patient contacted emergency services with abdominal and anal pain that had gradually increased over nearly 6 hours. Detailed medical history of patient revealed that he had inserted a foreign object into rectum and that he had occasionally done so to achieve sexual satisfaction over period of nearly 2 years. Patient stated that he had placed glass mineral water bottle in a glove and covered it with lubricating gel before inserting it into his rectum, but this time he couldn’t remove it. On physical examination, abdomen was relaxed and natural. Complete blood cell count (CBC) and biochemical parameters were within normal range. On digital rectal examination, base of bottle was palpated as solid object 5-6 cm proximal to anus. Standing abdominal radiographs of patient were obtained in emergency department for differential diagnosis, and showed bottle in the rectum without any evidence of free air or air-fluid levels. (Figure 1).
Anal canal was dilated under sedation anesthesia; however, foreign body could not be extracted. Retroscopy under general anesthesia revealed base of bottle had completely occluded the lumen, and procedure was unsuccessful. Infraumbilical incision was performed and during exploration, foreign object was palpated in the colon. Manual effort to eject object from the outside also failed. Colotomy was then performed, and bottle was extracted in its entirety and without breakage (Figure 2). Colon was closed and there was no indication of intra-abdominal fluid or perforation. Postoperative period was uneventful. Psychiatric consultation and follow-up at outpatient clinics of psychiatry and general surgery were recommended prior to hospital discharge.