Foreign Bodies) Leading to Intestinal Obstruction in a Mentally Ill Patient: Case Report and Literature Review Mohammad Bukhetan Alharbi *

International Journal of Surgery Open 4 (2016) 31–32

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International Journal of Surgery Open

journal homepage: www.elsevier.com/locate/ijso

Case Report Intentional impaction of rectum by mattress sponge pieces (foreign bodies) leading to intestinal obstruction in a mentally ill patient: Case report and literature review Mohammad Bukhetan Alharbi *

Department of Surgery, Medical College, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), PO Box 5701, Riyadh 11543, Saudi Arabia

ARTICLE INFO ABSTRACT

Article history: Background: It is more diﬃcult for the treating team to make the right diagnosis at the right time in Received 12 May 2016 mentally ill patients due to poor history and sometimes a masked clinical presentation. The presence of Received in revised form 3 July 2016 an unprofessional guardian may increase the challenges, as in our case, due to hidden or even mislead- Accepted 4 July 2016 ing history, especially with an older age group. Intentionally inserted sponge material in the rectum to Available online 8 July 2016 reduce the frequency of loose stool evacuations in patients with diarrhoea is a new phenomenon not discussed in medical literature. Keywords: Case summary: We report a case of an 85-year-old bedridden female with a history of stroke, hemiple- Rectum Foreign body gia, and dysarthria. She presented to our emergency department with signiﬁcant abdominal distention Mattress sponge and vomiting. She was attended by an unprofessional guardian (hired by her family). The history pro- Intestinal obstruction vided by the guardian was of abdominal distention and constipation 5 days prior to presentation, followed by vomiting feculent material. A physical examination revealed she had a distended tympanic abdomen without organomegaly, scars, or hernia. A digital rectal exam revealed a few pieces of a foreign body similar to sponge material with a fully distended rectum with well-formed stool. The guardian admitted that this was a sponge material used by her to reduce the frequency of stool evacuation. Removal of the foreign body by the medical team led to complete recovery in the same day. Conclusion: The treating team may face more challenges in treating patients with an inability to provide a proper history, especially if accompanied by an unprofessional guardian. © 2016 The Author. Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction dysarthria secondary to old CVA. Her history was given by the guardian. The patient had abdominal distention and constipation 5 days The reasons for the insertion of rectal foreign bodies vary from prior to presentation, followed by feculent material vomitus. She sexually oriented purposes, assaults and other criminal acts, to in- had no previous abdominal surgeries and no abdominal wall hernia tentional placement [1]. Many publications have discussed the types complaints. A physical examination revealed stable vital signs and of foreign bodies found in the rectum, the effect of location on man- she was not in agony. She had a highly distended abdomen, tym- agement, and the different manoeuvres used to extract them [2,3]. panic, without peritoneal irritation signs. There were no scars on Despite that it is obvious that the management of foreign bodies the abdominal wall and no signs of hernia. A digital rectal exam re- in the rectum requires a well-organized process [4], the interrup- vealed three medium-sized pieces of material, like pieces of sponge, tion of faecal passage intentionally, with or without criminal amalgamated together at the level of the anorectal junction, with intention, is unusual. a full rectum with soft stool. There were no features of anal pa- thology. A manual evacuation was performed successfully. Abdominal 2. Case presentation X-rays showed a highly dilated small and large bowel, without spe- ciﬁc features otherwise. The laboratory results were normal. On An 85-year-old female presented to our emergency depart- interviewing the guardian (non-professional), she admitted using ment with her guardian (hired by her family). The patient had sponge material from the patient’s mattress to reduce the frequency of passage of loose stools 2 weeks prior to the incident. She could not extract it afterwards. A Fleet enema was then used, followed by the passage of a large * Department of Surgery, Medical College, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), PO Box 5701, Riyadh 11543, Saudi Arabia. amount of stool and gases. The patient felt completely recovered E-mail address: [email protected], [email protected]. in 12 hours and was sent home. A routine follow-up was uneventful. http://dx.doi.org/10.1016/j.ijso.2016.07.001 2405-8572/© 2016 The Author. Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). 32 M.B. Alharbi / International Journal of Surgery Open 4 (2016) 31–32

3. Discussion References

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