British Journal of Obstetrics and Gynaecology December 1975. Vol 82. pp 1005-1006
A FOREIGN BODY IN THE RECTUM PRESENTING AS A VULVAL ABSCESS A CASE REPORT BY
G . A. ALETOR General Hospital, Auchi, Mid-West, Nigeria* Summary A case of trans-rectal impaction of a foreign body in the perineum is reported. The importance of rectal palpation during pelvic examination is re-emphasized. IN 1971, a 30-year-old Nigerian farmer complained of a painful vulval swelling, dated from an act of defaecation three weeks previously. As she squatted in an undergrowth for the act, she heard the cracking of a breaking stick-the stump of which she pushed away from underneath her anus. Subsequent acts of defaecation were increasingly painful. On examination there was a tender cystic swelling about 3 cm in diameter arising from the lower one-fifth of the left labium majus and involving the fourchette, simulating a Bartholin’s cyst. Vaginal examination was impossible because of the vulval tenderness. On rectal examination, a piece of stick was discovered with the lower pole embedded in the perineal body. The upper end could not be reached by the exploring finger. Under general anaesthesia and through a proctoscope a piece of twig, with the upper end free, and measuring 13 cm in lengthxO.5 cm in diameter, was disimpacted and removed. Through a counterincision over the vulval swelling, pus which had collected around the lower end of the stick was evacuated. Follow-up after two weeks showed marked resolution of the inflammatory process and narrowing of the
fistula which was created. Six weeks after the operation, the fistula had closed spontaneously.
DISCUSSION This patient squatted directly over a pointing dry twig and part of it broke and was retained in her rectum. During defaecation in the human, the column of faeces normally descends downwards and forwards at first and finally downwards backwards The resulting anatomic curve between the rectum and anal canal can be successfully negotiated by the malleable faeces but not by a long and rigid object like the stick found in this patient’s rectum. Further acts of defaecation will, therefore, tend to drive the stick downwards and forwards. The lower part of the stick impinged on the lower anterior rectal wall which was eventually perforated (Fig. 1). In the presence of pus, primary closure of the fistula was avoided. It is advisable to close fistula at least eight weeks after the initial operation when all inflammation should have subsided. While waiting, the fistula may close spontaneously as happened in this case. It is often stressed that pelvic examination is not complete without a rectal palpation and this case report emphasizes the correctness of this view.
* Present address: Department of Obstetrics and Gynaecology, Specialist Hospital, Benin City, Mid-West, Nigeria. 1005
1006 ALETOR
abscess
FIG. 1 The relationship of the stick in the rectum to the vulva1 abscess and perineal body as seen from the side.
A FOREIGN BODY IN THE RECTUM PRESENTING AS A VULVAL ABSCESS A CASE REPORT BY
G . A. ALETOR General Hospital, Auchi, Mid-West, Nigeria* Summary A case of trans-rectal impaction of a foreign body in the perineum is reported. The importance of rectal palpation during pelvic examination is re-emphasized. IN 1971, a 30-year-old Nigerian farmer complained of a painful vulval swelling, dated from an act of defaecation three weeks previously. As she squatted in an undergrowth for the act, she heard the cracking of a breaking stick-the stump of which she pushed away from underneath her anus. Subsequent acts of defaecation were increasingly painful. On examination there was a tender cystic swelling about 3 cm in diameter arising from the lower one-fifth of the left labium majus and involving the fourchette, simulating a Bartholin’s cyst. Vaginal examination was impossible because of the vulval tenderness. On rectal examination, a piece of stick was discovered with the lower pole embedded in the perineal body. The upper end could not be reached by the exploring finger. Under general anaesthesia and through a proctoscope a piece of twig, with the upper end free, and measuring 13 cm in lengthxO.5 cm in diameter, was disimpacted and removed. Through a counterincision over the vulval swelling, pus which had collected around the lower end of the stick was evacuated. Follow-up after two weeks showed marked resolution of the inflammatory process and narrowing of the
fistula which was created. Six weeks after the operation, the fistula had closed spontaneously.
DISCUSSION This patient squatted directly over a pointing dry twig and part of it broke and was retained in her rectum. During defaecation in the human, the column of faeces normally descends downwards and forwards at first and finally downwards backwards The resulting anatomic curve between the rectum and anal canal can be successfully negotiated by the malleable faeces but not by a long and rigid object like the stick found in this patient’s rectum. Further acts of defaecation will, therefore, tend to drive the stick downwards and forwards. The lower part of the stick impinged on the lower anterior rectal wall which was eventually perforated (Fig. 1). In the presence of pus, primary closure of the fistula was avoided. It is advisable to close fistula at least eight weeks after the initial operation when all inflammation should have subsided. While waiting, the fistula may close spontaneously as happened in this case. It is often stressed that pelvic examination is not complete without a rectal palpation and this case report emphasizes the correctness of this view.
* Present address: Department of Obstetrics and Gynaecology, Specialist Hospital, Benin City, Mid-West, Nigeria. 1005
1006 ALETOR
abscess
FIG. 1 The relationship of the stick in the rectum to the vulva1 abscess and perineal body as seen from the side.
