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A 54-year-old man presented with the complaint that two days earlier he had drunk whiskey and `did something` to his rectum. He was obviously embarrassed and reluctant to explain his problem. Rectal examination revealed a hard, smooth, globular mass. The results of the rest of the physical examination were within normal limits.

When asked specifically, the patient admitted that an electric bulb had been in his rectum for two days. He said he had gotten drunk, accepted a wager of $100 and, using shaving cream as a lubricant, had inserted a 100-watt electric bulb into his rectum. The next day, sober, he realized that he had done a `stupid` thing but believed that the bulb would come out unassisted. After two days he became aware of difficulty defacating, and when he began to experience difficulty urinating, he became frightened and sought medical help.

AP and lateral films of the pelvis verified the location of the electric bulb in the rectum, and the patient was taken to the operating room. He was placed in a face-down position with his hips elevated. The buttocks were separated and held apart by a circular metal ring. With the aid of malleable retractors in the rectum, the electric bulb was visualized, but it was not possible to get a gloved finger over the maximum diameter of the bulb.

Toy darts with suction cup ends were used to draw the electric bulb to the sphincter. After drying the glass surface of the bulb with ethyl ether swabs, we attempted to attach the suction cup end of the dart to the eletric bulb with cyanoacrylate cement. Four attempts of this maneuver were unsuccessful: the cement would not stick.

The patient was then turned to the lithotomy position and another dart was successfully attached to the bulb without any glue, and the bulb was pulled to the sphincter. Three #24 Foley catheters with 30-cc terminal balloons were lubricated with mineral oil and passed over the maximum diameter of the bulb. The catheters were placed at the six, ten and two o`clock positions. Throughout this procedure, a steady pull was maintained on the attached dart.

After it was verified by digital examination that the tips and balloons of the catheters were beyond the maximum diameter of the bulb, the balloons were inflated with 30 cc of water, and about 30 cc of mineral oil was injected into the rectum through a Foley catheter. A steady pull of about five pounds was applied to each catheter, and after about ten minutes the sphincter began to dilate and the bulb began to emerge.

The electric bulb finally came out through the external sphincter with no further complications. Sigmoidoscopic examination showed no bleeding or other injury to the rectal mucosa. After 24 hours of observation, the patient returned home.

The literature describes various methods that have been employed to retrieve foreign bodies from the rectum. Because this electric bulb was a large object (maximum diameter, 61 mm; length from metal end to top, 114 mm) made of fragile glass, special consideration had to be taken to avoid breakage that would have resulted in lacerations to the rectum and adjacent structures, with consequent complications.

Ideally, the bulb should be removed intact from the rectum through the anus. If this is not possible, the abdomen must be opened and the bulb gently squeezed through the rectum and the anus, with great care taken to avoid injuring the rectum. Should this method be unsuccessful, the sigmoid colon must be opened and the bulb removed through the abdominal incision; however, opening the sigmoid colon is a very lenghy procedure with severe morbidity and a prolonged recovery period, and this maneuver should be reserved as an extraordinary measure.

CASE REPORT

A 20-year-old man presented to the emergency room complaining of rectal pain. A well-nourished, well-developed man without signs of intoxication was admitted in no apparent distress. Digital examination of the rectum revealed a stony hard mass. Abdominal plain films showed a vertically oriented, low-lying radiopaque object in the rectum. A spherical radiolucency was noted in the upper pole of the mass. A blood alcohol level was negative. No other drug testing was performed.

Upon further questioning, the patient said that approximately 4 hrs earlier he and his boyfriend had been "fooling around." After stirring a batch of concrete mix, the patient laid on his back with his feet against the wall at a 45-degree angle while his boyfriend poured the mixture through a funnel into his rectum. After the concrete mass hardened, it became so painful that he sought medical care.

Under general anesthesia, the anus was dilated and two Foley catheters were inserted alongside the rectal mass to relieve suction. A concrete case of the rectum was delivered without incident. The rectal mucosa was intact with a hyperemic and edematous appearance.

The patient was kept overnight and discharged uneventfully the following morning. The attending physician recommended a psychiatric consultation, but the patient declined.

PATHOLOGIC EXAMINATION

Examination of the specimen revealed a perfect concrete cast of the rectum, measuring 12 X 7 X 5 cm and weighing 275 g (Fig. 2). A thin layer of feces coated the surface and crevices. Grooves in the mass were consistent with rectal mucosal folds. A layer of concrete was chipped off the upper part of the specimen and revealed a white plastic ping-pong ball. This corresponded to the radiolucency observed in the abdominal x-ray.

And folks call ME depraved!!!