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Shell in the rectum
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  1. Yoji Shibaike1,
  2. Takanobu Hirosawa2,
  3. Taro Shimizu2
  1. 1Department of Family Medicine, Okinawa Yaeyama Hospital, Okinawa, Japan
  2. 2Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
  1. Correspondence to Dr Takanobu Hirosawa, t.hirosawa1983{at}gmail.com

https://doi.org/10.1136/bcr-2017-221125

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    Description

    A 67-year-old man with Down syndrome with intellectual disability presented with fever and cough. He denied abdominal pain or any change in bowel movement. His abdominal examination was unremarkable. A contrast-enhanced CT of the chest and abdomen performed for the fever work-up incidentally revealed a sharp-edged foreign body in the rectum without perforation (figure 1, online supplementary video). A colonoscopy disclosed a conch shell, 5 cm in length, caught in the rectum (figure 2). Further history clarified that he mistakenly swallowed the chopstick rest made with a shell at a restaurant in Ishigaki Island, Okinawa, Japan. His fever was attributed to pneumonia, and after intravenous antibiotic therapy for several days the fever remitted. He was transferred to his residential facility. He was concluded as having swallowed shell, which transferred to the rectum after his swallowing.

    Supplementary Material

    Supplementary Video
    Figure 1
    Figure 1

    Pelvic CT showing a sharp-edged foreign body.

    Figure 2
    Figure 2

    (A,B) A shell in the rectum.

    The%20rectum and the oesophagus are two main locations of foreign bodies.1 Many objects have been described as retained rectal foreign bodies.2 The gastrointestinal sequelae depend on the type of object and its location.3

    A clear history of foreign body ingestion may be lacking.1 There are a variety of presentations with foreign bodies: may be asymptomatic, rectal pain, bleeding, pruritus, intestinal obstruction or rectal abscess.2

    Plain X-ray and CT are useful tests to confirm the location of foreign bodies and associated complications. Fortunately, 80%–90% of ingested foreign objects that reach the stomach will pass without intervention.1 In clinically unstable patients with evidence of perforation or peritonitis, emergent surgery should be considered.

    Learning points

    • Although rare, shell can be a foreign body in digestive tract.

    • Rectum and oesophagus are two main locations of foreign bodies.

    • Most ingested foreign bodies that reach the stomach will pass without intervention.

    References

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      . Foreign bodies. Gastrointest Endosc Clin N Am 2007;17:361–82.doi:10.1016/j.giec.2007.03.002
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      1. Goldberg JE,
      2. Steele SR
      . Rectal foreign bodies. Surg Clin North Am 2010;90:173–84.doi:10.1016/j.suc.2009.10.004
      OpenUrlCrossRefPubMedWeb of Science
    3. ↵
      1. Frossard JL,
      2. de Peyer R
      . An unusual digestive foreign body. Case Rep Gastroenterol 2011;5:201–5.doi:10.1159/000326925
      OpenUrlPubMed
    View Abstract

    Footnotes

    • Contributors YS and TH were equally involved in the care of the patient. YS, TH and TS were equally involved in creation of the image and writing of the report. Written consent to publication was obtained.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.