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CASE REPORT
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 275-277  

Retained rectal foreign body in a child operated for high anorectal malformation


Department of Pediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India

Date of Submission02-Oct-2018
Date of Acceptance23-Mar-2019
Date of Web Publication15-May-2019

Correspondence Address:
Rajendra Kumar Ghritlaharey
Department of Pediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal - 462 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_173_18

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  Abstract 


Foreign body ingestion is not uncommon in pediatric age group. Foreign bodies including coin retention/impaction at the colorectal regions are less frequently reported in children and extremely rare in the operated cases of anorectal malformation (ARM). The present case is a 5.8-year-old boy who had retention of ingested foreign body (coin) in his rectum for 4 months. His history revealed that he was a case of high ARM which was managed with three-staged procedures. His clinical examination and radiological investigations revealed an anal stricture and a foreign body (coin) in his rectum. He was managed well with anal dilatation and removal of coin under general anesthesia. The intention for presenting the case is its rarity.

Keywords: Anorectal malformation, children, foreign body ingestion, rectal foreign body


How to cite this article:
Ghritlaharey RK. Retained rectal foreign body in a child operated for high anorectal malformation. Med J DY Patil Vidyapeeth 2019;12:275-7

How to cite this URL:
Ghritlaharey RK. Retained rectal foreign body in a child operated for high anorectal malformation. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 May 25];12:275-7. Available from: http://www.mjdrdypv.org/text.asp?2019/12/3/275/258204




  Introduction Top


Ingestion of varieties of foreign body is not uncommon in pediatric age group.[1],[2] The most common foreign body ingested by children is coin, and other foreign bodies are small toys, part of toys, button batteries, magnets, bones, safety pins, and erasers.[1],[2] The most common site in the gastrointestinal tract for foreign body impaction is upper esophagus and is frequently managed with endoscopic removal and by other methods.[2],[3],[4] Retained/impacted foreign bodies in the colorectal region were also reported, but mostly in adults, and needed endoscopic and surgical intervention for its removal.[5],[6] Failure to pass an ingested foreign body through the anal canal is extremely rare in the cases operated for anorectal malformation (ARM).[7]


  Case Report Top


A 5.8-year-old boy was referred with a history of inability to pass ingested foreign body (coin) through his rectum/anus. Parents of the child also said that he was passing stool like a paste. This coin was retained in his rectum for 4 months without any symptoms and signs relating to the ingested foreign body. His history revealed that he had been operated for high ARM that was managed with three-staged procedures: sigmoid colostomy, abdominoperineal pull-through of the colon, and colostomy closure. Regular follow-up and anal dilatation were advised by an operating surgeon. Neither regular anal dilation was done at home nor reported for follow-up to the operating surgeon. His general examination was normal. His abdominal examination revealed that there were healed scars of previous operations seen in his left lower abdomen. Anal examination revealed that there was anal stenosis/stricture and allowed only infant feeding tube of size 10. Skiagram of the abdomen including the chest (anteroposterior [AP] and lateral views) showed a radio-opaque shadow (foreign body/coin) in his left side of the upper abdomen [Figure 1]a. He had neither symptoms nor signs of foreign body/coin ingestion and therefore there was no need of admission. Skiagram of the abdomen was repeated after a week, which showed a radio-opaque shadow in the pelvic area/near the pubic symphysis [Figure 1]b. Barium enema was also done, which revealed that there was an anal stricture [Figure 2]a and also showed a radio-opaque foreign body within the rectum [Figure 2]b. Abdominal computed tomography showed a foreign body of 2.4 cm × 1.6 cm and also reported that it was 6 cm above the anal verge.
Figure 1: (a) Skiagram of the chest and abdomen (anteroposterior and lateral views) showing radio-opaque shadow/foreign body (coin) in the left upper abdomen. (b) Skiagram of the abdomen showing radio-opaque shadow/foreign body in the pelvic area, near the pubic symphysis

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Figure 2: (a) Barium enema showing anorectal stricture. (b) Barium enema showing foreign body shadow within the rectum

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Under general anesthesia, anorectal examination revealed that there was stenosis at the anocutaneous junction. Anal dilation was done with Hagar's anal dilator up to no. 15 which was sufficed to break the anocutaneous stenosis. Rest of the anal canal was normal. Rectal digital examination was done to palpate the coin in the rectum. Artery forceps was inserted gently alongside of the per-rectally inserted finger. Gentle per-abdominal pressure was also applied to push the coin downward. One rupee coin was grasped with the artery forceps and was removed easily [Figure 3]. His postoperative period was excellent, and he was discharged on the 3rd postoperative day. The last follow-up was done 3 months after the removal of rectal coin and he was doing well. He was passing stool normally and had no fecal soiling, and his anal digital examination was also normal.
Figure 3: Per-operative photograph showing coin at the anal verge

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  Discussion Top


Ingestion of foreign bodies is common in the pediatric age group and is more frequently observed during the age of 6 months–5 years.[1] Some of the ingested foreign bodies are dangerous and hazardous and responsible for possible complications such as bowel perforations, infections, obstruction, gastrointestinal bleeding, and requiring immediate removal/intervention to prevent complications.[2] Most foreign bodies (80%) pass through the gastrointestinal tract easily, 10%–20% of them require endoscopic removal, and 1% or less require operative intervention for their removal.[1],[8]

Foreign bodies including coin impaction at the colorectal regions are less frequently reported in children.[8],[9] They may present as chronic abdominal pain, lower gastrointestinal bleeding, and intestinal obstruction.[8],[9] Impacted colorectal foreign bodies require radiological and endoscopic evaluation and require transanal digital/instrumental extraction, endoscopic, or laparotomy for the retrieval of the foreign bodies.[5],[6],[8],[9] Anal/anorectal stricture of neo-anus is a known complication following surgical procedures done for the correction of ARMs. Management of such a case may require simple anal dilatation at home, anal dilatation/redo-anoplasty under anesthesia, or may require major redo procedures.[10],[11],[12]

This patient presented with retention of his ingested coin in his rectum due to the presence of anal stricture that developed following the management of high ARM. The coin was retained in his rectum without any complication for 4 months, prior to the operative removal. A regular follow-up was not there for this child after the stoma closure, and therefore, early detection of anal stenosis was missed.


  Conclusion Top


Anal stenosis and anal stricture are known complications following surgical procedures done for ARMs. Failure to pass an ingested coin through the anal canal due to anal stricture that developed following the surgical procedures done for the management of ARM is very rare.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dereci S, Koca T, Serdaroǧlu F, Akçam M. Foreign body ingestion in children. Turk Pediatri Ars 2015;50:234-40.  Back to cited text no. 1
    
2.
Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: Presentation, complications, and management. Int J Pediatr Otorhinolaryngol 2013;77:311-7.  Back to cited text no. 2
    
3.
Heinzerling NP, Christensen MA, Swedler R, Cassidy LD, Calkins CM, Sato TT. Safe and effective management of esophageal coins in children with bougienage. Surgery 2015;158:1065-70.  Back to cited text no. 3
    
4.
Waltzman ML. Management of esophageal coins. Curr Opin Pediatr 2006;18:571-4.  Back to cited text no. 4
    
5.
Cologne KG, Ault GT. Rectal foreign bodies: What is the current standard? Clin Colon Rectal Surg 2012;25:214-8.  Back to cited text no. 5
    
6.
Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart RW Jr. Management of retained colorectal foreign bodies: Predictors of operative intervention. Dis Colon Rectum 2004;47:1694-8.  Back to cited text no. 6
    
7.
Ameh EA, Nmadu PT. Gastrointestinal obstruction from phytobezoar in childhood: Report of two cases. East Afr Med J 2001;78:619-20.  Back to cited text no. 7
    
8.
Müller KE, Arató A, Lakatos PL, Papp M, Veres G. Foreign body impaction in the sigmoid colon: A twenty euro bet. World J Gastroenterol 2013;19:3892-4.  Back to cited text no. 8
    
9.
Somani SK, Ghosh A, Awasthi G. Endoscopic removal of a coin impacted at the ileocecal valve with small bowel obstruction. Trop Gastroenterol 2009;30:149-50.  Back to cited text no. 9
    
10.
Holbrook C, Misra D, Zaparackaite I, Cleeve S. Post-operative strictures in anorectal malformation: Trends over 15 years. Pediatr Surg Int 2017;33:869-73.  Back to cited text no. 10
    
11.
Brisighelli G, Morandi A, Di Cesare A, Leva E. The practice of anal dilations following anorectal reconstruction in patients with anorectal malformations: An international survey. Eur J Pediatr Surg 2016;26:500-7.  Back to cited text no. 11
    
12.
Levitt MA, Peña A. Complications after the treatment of anorectal malformations and redo operations. In: Holschneider AM, Hutson JM, editors. Anorectal Malformations in Children. Springer-Verlag; Berlin Heidelberg 2006. p. 319-26.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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