Colonoscopic removal of balloons t from the bowel Leon Wolf, MD Kevin Geraci, MD* Division of Gastroenterology Department of Medicine
Figure 2. Endoscopic view of balloon occupying the lumen of the splenic flexure.
St. Luke's Hospital and Case-Western Reserve University School of Medicine Cleveland, Ohio
Fiberoptic endoscopy has been useful in retrieving foreign objects in the upper gastrointestinal tract.' Surgery and sigmoidoscopy hcwe been used for retrieving objects in the colon or rectum."· We report a case in which 2 objects were retrieved with a colonoscope from the colon. CASE REPORT The day before admission a 32-year-old executive experimented with different sexual stimulatory activities with a female companion. During one of these activities, a half dozen water-filled balloons were introduced into the patient's rectum. He assumed all the balloons had been evacuated. However, later that day the patient experienced dull right upper quadrant cramps and tenesmus. The tenesmus and cramps became increasingly severe throughout the night. The following morning he visited his physician who obtained an abdominal radiograph (Figure 1). The outline of one of the balloons was seen at the hepatic flexure and that of
Figure 3. The 2 balloons: lasciviously inserted, endoscopically extracted.
another balloon was suggested at the splenic flexure. The patient was referred for colonoscopy. The physical examination was normal except for mild tenderness in the right upper abdominal quadrant. There were no distention nor palpable masses. Endoscopy was performed using an Olympus CF Type MB-2. The first balloon was seen at the splenic flexure (Figure 2). It was punctured and removed with a Medi-Tech MPF/201120 grasping forceps. The colonoscope was re-introduced, and another balloon was located at the hepatic flexure. This balloon was wedged tightly in the promi nent haustra of the transverse colon. The first attempt at removal only stretched the balloon to a pointed configuration. The second attempt successfully removed the balloon, still filled with water but leaking through a puncture (Figure 3). The procedure was well tolerated. There were no complications. DISCUSSION Insertion of objects into the rectum has been reported mainly in children or psychiatric patients. In the recent literature, anal stimulation and abuse with objects has been reported as a sexual preference. 304 In one survey, 9% of male homosexuals had experienced rectal insertion of objects. s Most objects do not go higher than the sigmoid colon and can be removed by means of the sigmoidoscope. Objects which have been reported as being impacted higher in the colon were invariably swallowed.' This case illustrates that an object of proper size and shape can traverse the colon after rectal insertion and then become impacted. In addition, the value of colonoscopy was shown, not only in demonstrating that the 2 balloons were stuck in the colon but also by obviating the need for surgical intervention. Thus, colonoscopy is effective in removing not only polyps but also balloons. REFERENCES Fiberendoscopic removal of foreign bodies from the upper intestinal tract. Gastrointestinal Endoscopy 21:58, 1974 BEALL Ac, DEBAKEY ME: Injuries and foreign bodies ofthecolon and rectum in Diseases of the Colon and Rectum. W. B. Saunders, Philadelphia, 1969. p. 872 TUREll R: Sexual problems as seen by a proctologist NY State J Med 74:697, 1974 DENKO jD: Klismaphilia: enema as a sexual preference. Am J Psychother 27:232, 1973 SAGHIR MT, ROBBINS E: Male and Female Homosexuality. Baltimore, Williams and Wilkins Co., 1973, p. 52 HAFT jS, BENJAMIN HW, WAGNER M: Br Med 1,1:626,1976
1. OLSEN H, LAWRENCE W, BERSTEIN R:
Figure 1. Abdominal radiograph showing a water-filled balloon at the hepatic flexure and a faint outline of a collapsed balloon at the splenic flexure. tThis article is rated PG: due to its mature theme, this report should be perused only with parental guidance. 'Reprint requests: Kevin Geraci, MD, SI. Luke's Hospital, 11311 Shaker Boulevard, Cleveland, Ohio 44104. VOLUME 24, NO.1, 1977
2.
3. 4. 5. 6.
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Figure 2. Endoscopic view of balloon occupying the lumen of the splenic flexure.
St. Luke's Hospital and Case-Western Reserve University School of Medicine Cleveland, Ohio
Fiberoptic endoscopy has been useful in retrieving foreign objects in the upper gastrointestinal tract.' Surgery and sigmoidoscopy hcwe been used for retrieving objects in the colon or rectum."· We report a case in which 2 objects were retrieved with a colonoscope from the colon. CASE REPORT The day before admission a 32-year-old executive experimented with different sexual stimulatory activities with a female companion. During one of these activities, a half dozen water-filled balloons were introduced into the patient's rectum. He assumed all the balloons had been evacuated. However, later that day the patient experienced dull right upper quadrant cramps and tenesmus. The tenesmus and cramps became increasingly severe throughout the night. The following morning he visited his physician who obtained an abdominal radiograph (Figure 1). The outline of one of the balloons was seen at the hepatic flexure and that of
Figure 3. The 2 balloons: lasciviously inserted, endoscopically extracted.
another balloon was suggested at the splenic flexure. The patient was referred for colonoscopy. The physical examination was normal except for mild tenderness in the right upper abdominal quadrant. There were no distention nor palpable masses. Endoscopy was performed using an Olympus CF Type MB-2. The first balloon was seen at the splenic flexure (Figure 2). It was punctured and removed with a Medi-Tech MPF/201120 grasping forceps. The colonoscope was re-introduced, and another balloon was located at the hepatic flexure. This balloon was wedged tightly in the promi nent haustra of the transverse colon. The first attempt at removal only stretched the balloon to a pointed configuration. The second attempt successfully removed the balloon, still filled with water but leaking through a puncture (Figure 3). The procedure was well tolerated. There were no complications. DISCUSSION Insertion of objects into the rectum has been reported mainly in children or psychiatric patients. In the recent literature, anal stimulation and abuse with objects has been reported as a sexual preference. 304 In one survey, 9% of male homosexuals had experienced rectal insertion of objects. s Most objects do not go higher than the sigmoid colon and can be removed by means of the sigmoidoscope. Objects which have been reported as being impacted higher in the colon were invariably swallowed.' This case illustrates that an object of proper size and shape can traverse the colon after rectal insertion and then become impacted. In addition, the value of colonoscopy was shown, not only in demonstrating that the 2 balloons were stuck in the colon but also by obviating the need for surgical intervention. Thus, colonoscopy is effective in removing not only polyps but also balloons. REFERENCES Fiberendoscopic removal of foreign bodies from the upper intestinal tract. Gastrointestinal Endoscopy 21:58, 1974 BEALL Ac, DEBAKEY ME: Injuries and foreign bodies ofthecolon and rectum in Diseases of the Colon and Rectum. W. B. Saunders, Philadelphia, 1969. p. 872 TUREll R: Sexual problems as seen by a proctologist NY State J Med 74:697, 1974 DENKO jD: Klismaphilia: enema as a sexual preference. Am J Psychother 27:232, 1973 SAGHIR MT, ROBBINS E: Male and Female Homosexuality. Baltimore, Williams and Wilkins Co., 1973, p. 52 HAFT jS, BENJAMIN HW, WAGNER M: Br Med 1,1:626,1976
1. OLSEN H, LAWRENCE W, BERSTEIN R:
Figure 1. Abdominal radiograph showing a water-filled balloon at the hepatic flexure and a faint outline of a collapsed balloon at the splenic flexure. tThis article is rated PG: due to its mature theme, this report should be perused only with parental guidance. 'Reprint requests: Kevin Geraci, MD, SI. Luke's Hospital, 11311 Shaker Boulevard, Cleveland, Ohio 44104. VOLUME 24, NO.1, 1977
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3. 4. 5. 6.
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