Sunday, December 7, 2008

Rectal Impaction Following Enema with Concrete Mix



A 20-year-old white homosexual 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 (Figure 1). A spherical radiolucency was noted in the upper pole of the mass....

Upon further questioning, the patient said that approximately 4 h 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% 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 cast 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.


[Peter J. Stephens, M.D. and Martz L. Taff, M.D. in The American Journal of Forensic Medicine and Pathology, Vol. 8, No. 2, 1987, as excerpted in Amok Journal.]

Figure 1. Abdominal roentgenogram showing impacted radiopaque mass filling the rectum. Note the radiolucent ping-pong ball in the upper portion (arrow).


Figure 2. Concrete cast recovered from a man's rectum showing grooves produced by mucosal folds. Ping-pong ball is encased in concrete (arrow).

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