We report the case of an 80-year-old female patient referred to our hospital with suspicion of a rectal foreign body. Three days after undergoing right hip hemiarthroplasty, she started to experience lower crampy abdominal pain and aqueous non-bloody diarrhea. Her vital signs were normal. Physical examination revealed abdominal tenderness without guarding. Blood tests showed leukocytosis and raised inflammatory markers.
A pelvic X-ray showed a Steinmann pin that penetrated the pelvis. Computed tomography (CT) scan confirmed rectal perforation without signs of peritonitis (Fig. 1). A rectoscopy performed under CO2 insufflation disclosed a metal rod traversing the lower rectum and obstructing the lumen (Fig. 2). The mucosa was normal with no stigmata of hemorrhage.
Figure 1 Radiograph of the pelvis (A) and computed tomography scan (B) with gap correction showing the Steinmann pin traversing he pelvis
Figure 2 Rectal endoscopy showing a metal wire perforating the rectum side-to-side, and partially occluding the lumen
Pin extraction was conducted through the same previous surgical approach. The patient was put on broad-spectrum antibiotics for one week despite negative cultures from the surgical site. A CT scan performed 3 days later showed fat stranding of the mesorectum but no abscess.
Usually, rectal foreign bodies are secondary to sexual practice, constipation or treatment of prolapsed hemorrhoids. However, post-surgical rectal foreign bodies have been described: an orthopedic Kirschner wire in a 74-year-old man one year after treatment for a left hip fracture, migration of a hemostatic Weck clip after laparoscopic prostatectomy, and several cases of perforated intrauterine contraceptive devices with rectal involvement [1-3]. In all cases, surgery combined with broad-spectrum antibiotics was successful.