Visual diagnosis: Rectal foreign body: A primer for emergency physicians

A 39-year-old male presented to the Emergency Department with vague complaints of abdominal pain and constipation. He stated that the abdominal pain was dull and crampy in nature and generalized in distribution. Furthermore, he stated that he had not had a bowel movement in 2 days, though he felt as if he had to have one. He denied constitutional complaints of fevers, chills, nausea, and vomiting, and denied urinary complaints as well.The patient's vital signs were: temperature 37.2°C, pulse 87 beats per minute, respiratory rate of 20 per minute, and blood pressure 130/84 mmHg. The patient was awake, alert, and oriented to time, person, and place. His head, neck, cardiovascular, respiratory, and neurologic exams were all documented as within normal limits. His abdominal exam revealed a flat abdomen, diffusely tender with bowel sounds in all four quadrants. The physician noted a palpable mass in the left lower quadrant. Upon further examination, the mass felt "very hard" and had an "oblong" shape according to the physician notes. The patient was subsequently re-questioned about a family history of cancer, which the patient denied. The physician subsequently ordered basic laboratory tests and an abdominal X-ray. The AP and lateral X-rays are shown in Figures 1 and 2.After obtaining the X-rays, the physician presented the X-rays to the patient and asked him what the object was. According to documentation, the patient replied that he did not know. The patient was subsequently placed in the left lateral decubitus position and an anoscope inserted. The object could not be visualized, and therefore no attempt was made to remove it. General surgery was consulted to see the patient and decided to take him to the operating room for removal. The patient agreed to this.The object was noted to be the extension arm of a vacuum cleaner. It was removed according to notes with some difficulty and the patient was admitted to the hospital for observation and intravenous antibiotics. T