Rectal abscess secondary to foreign body insertion: A case report

Abstract

Background: Rectal foreign bodies, though uncommon, present diagnostic and therapeutic challenges, particularly when they result from accidental ingestion. The nonspecific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment. This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body, focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.

Case summary: A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia. Initial evaluation revealed hemodynamic stability and a tender, non-mucosal lesion in the anterior left rectal region. Imaging studies, including colonoscopy, magnetic resonance imaging, and endosonography, identified an erythematous, exophytic lesion and a perirectal abscess containing a foreign body. Surgical intervention revealed necrotic tissue and purulent material, along with two solid foreign body fragments (bone or plant matter). Postoperative follow-up showed the patient in good condition, and pathology confirmed the fragments as mature bone.

Conclusion: This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.

Keywords: Abscess; Case report; Chronic inflammation; Colonoscopic polypectomy; Endosonography; Rectal foreign bodies.

Figure 1

Erythematous, exophytic lesion in the distal rectum below the distal valve of Houston, proximal to the dentate line, measuring 13 mm × 10 mm, with an inflammatory, lobulated, and villous appearance, not involving more than 20% of the circumference or causing stenosis of the rectal lumen. A: Frontal view of the polyp; B: Lateral view of the polyp; C: Medial view of the polyp.

Figure 2

Successful endoscopic polypectomy using hot snare technique, with no bleeding observed at the resection site. A: Lateral view of the polyp resection; B: Frontal view of the polyp resection.

Figure 3

Intramural abscess and collection between the left iliococcygeal muscle and left prostatic lobe with thickened wall and peripheral enhancement post-contrast, along with a 34 mm linear hypodense lesion within the abscess (Foreign body). A: T1 sequence of magnetic resonance imaging; B: T2 sequence of magnetic resonance imaging.

Figure 4

Bone fragments extracted during surgical resection.