AUCTORES
Globalize your Research
Review Article
*Corresponding Author: David Fernando Toro Tole, Department of Surgery, Royal Darwin Hospital, Darwin, Australia.
Citation: Toro Tole DF, Joe Hedger, Rachel Yun, Amelie Maurel, (2024), A 20 Year Case Series of Anorectal Foreign Body Trauma in the Northern Territory of Australia, J, Surgical Case Reports and Images, 7(1); DOI:10.31579/2690-1897/176
Copyright: © 2024, David Fernando Toro Tole. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 February 2024 | Accepted: 19 February 2024 | Published: 28 February 2024
Keywords: anorectal trauma; general surgery; foreign body; surgery; rural and remote health
Backgrounds: Anorectal foreign body insertion is a practice reported as far back as the 16th century but practiced earlier. The incidence of associated anorectal trauma, particularly with a male predominance, has been increasing. The risk of delayed presentation in rural settings can impact surgical outcomes.
Methods: This is a case series of retained anorectal foreign body and resulting trauma in a tertiary hospital of the Northern Territory between 2003 and 2023. Data including demographics, foreign body, clinical presentation, surgical intervention, and complications were recorded.
Results: A total of 44 patients were identified. Majority of patients were male with a mean age of 37. and 14 patients living rural or remote. The primary method for management was transanal manual extraction (33 cases), sigmoidoscopy (11 cases) and laparotomy (3 cases). The main complications observed were perforation (3 cases), and Fournier’s Gangrene post anal sphincter repair. Delays in seeking medical attention were associated with increased rurality and further surgical implications.
Conclusion: The outcome of this study will be useful for health professionals to understand the potential challenges and complications associated with foreign body anorectal trauma in a rural setting with a delayed presentation time.
Anorectal trauma secondary to foreign body insertion is becoming more common, but precise epidemiological data are often lacking due to underreporting [1-2]. A higher incidence has been noted amongst males with a mean age of 48 years [3-5]. Retained foreign bodies, are usually those used for sexual and erotic stimulation, but also therapeutic purposes or assault [6]. A range of foreign bodies, including but not limited to light bulbs, bottles, sex toys, vegetables/fruits and screw drivers has been reported in anorectal trauma [1-6]. Early diagnosis and management is important given the risk of severe injury like perforation which can result in peritonism [1-6].
Delay in seeking medical attention is not uncommon due to personal and socio-cultural barriers [6]. Rurality can be a factor due to the increased travel time to access tertiary services. Reluctance to disclosure due to embarrassment can delay timely diagnosis and management. Management options include manual transanal extraction [1-7], showing a success rate ranging from 60% to 75% [1-8]. Unsuccessful bedside extraction should be re-approached with pudendal nerve block, spinal anaesthesia, sedation, or general anaesthesia. Unstable patients or those peritonitic, may warrant an exploratory laparoscopy or laparotomy [1-7].
Along with the rising trend in retained rectal foreign bodies, the presence of retained foreign bodies and anorectal trauma has been associated with increased healthcare expenditure, wasted theatre time, lost work days and overall warrants further investigation [1-9]. There is need for a growing body of evidence on the epidemiology and management of anorectal trauma and retained foreign bodies, as well as a better understanding of complications. This is particularly important in rural, remote, and very remote areas, where awareness of this can assist with decision-making to transfer or escalate care.
The aim of the investigation is to further describe the incidence and complications of anorectal trauma by foreign body insertion, and the treatments associated particularly in a rural/remote setting of Australia. This description can then be applied to further rural and remote regions of the world, and help to make more informed clinical decisions.
This is a retrospective case series identifying anorectal trauma at a single tertiary centre of the Northern Territory of Australia. The investigation started by collecting all Royal Darwin Hospital admissions coded for anorectal trauma from June 1st 2003 to June 1st 2023 to describe a 20 year picture. Patients included in the study were those who presented with a complaint of or a foreign body in their anus, rectum, or sigmoid colon to Royal Darwin Hospital. Patients were excluded if their anorectal trauma was due to mechanism other than foreign body insertion. Cases were identified using ICD codes, and data extracted from hospital records included demographics, relevant medical history, clinical presentation, motive for insertion, attempt at self-removal, investigations, surgical intervention, and outcome. This data was then processed into Microsoft Excel, which was used to conduct further statistical analysis.
Analysis was conducted using Microsoft Excel (Redmond USA).
Sociodemographic Characteristics
Over the 20-year period, 44 patients presented with foreign body anorectal trauma. Most patients were male (84%) with age distribution of 10 to 75 years and mean age of 37 years (Table 1). The highest incidence was among patients 36 to 45 years (27%). Patients presenting to the Emergency Department predominantly reported a lost foreign body as their primary concern (66%). Four patients were under the influence of alcohol, two cases in patients known to have schizophrenia, one case associated with child behavioural problems and one case in a patient with a traumatic brain injury.
Table 1. Sociodemographic characteristics of patients presenting with foreign body anorectal trauma
The most common motive was sexual pleasure (89%), whilst others were self-management of constipation, accidental, and drug smuggling. The type of foreign body objects found exhibited significant variability. Most of the objects were sex toys (36%), inorganic household items including bottles (27%), organic household items (14%), and 1 case of the tip of an enema syringe (2%). Unfortunately, due to damage to item and patient not wanting to disclose, 6 patients had “Unknown” foreign bodies causing trauma, representing 14% of total patients (Table 2). The most common presenting complaint was an earnest admission of losing a foreign body in rectum (66%), followed by lower abdominal pain (23%) with the least common presentations being suspected drug smuggling, impacted foreign body, and difficulty walking (2
This case series study holds significance as it marks the first of its kind in the Northern Territory, a predominantly rural location. In the cases observed over 20 years, most patients were male identifying, with a mean age of 37 years, aligning with the consistent pattern observed elsewhere [4,10,11]. The average age of this cohort (37 years) is a decade younger than what is reported in other studies (48 years) [3-5]. This left skewed age distribution may be attributed to a higher prevalence in younger individuals in the Northern Territory population, which according to the Australian Bureau of Statistics (2016) has a median age of 32 [12]. A prominent feature was 30% of patients living rural or remote. Out of the six patients who presented with a perforation, four of them were rural, with a delayed presentation time greater than 24 hours. This has been observed in other studies with a rural focus [11].
The variety of foreign body objects was consistent with the diversity reported in the literature. Sex toys were the most commonly inserted items. As anticipated among most cases, the predominant motive behind foreign body insertion was for sexual gratification accounting for 87% of cases. A growing societal acceptance of anal pleasure has likely contributed to males being more willing to enjoy anal pleasure with a sex toy regardless of sexuality [13,14]. Despite the increasing recognition, patients are still reluctant to disclose foreign body use. This is supported by the data on delay to presentation after 12 hours, attempt at self-removal prior to presentation and higher likelihood of presentation overnight (34% of cases). We identified other motives for foreign body use including enema use for constipation and drug smuggling. However, the use of foreign bodies has been reported elsewhere as a consequence of rape or sexual assault [15]. Hence, health care professionals should be mindful of the motive, and maintain a high level of suspicion in cases with an incongruent history.
In the Northern Territory, most cases were managed by transanal extraction under general anaesthesia in theatre. This assists in reducing sphincter spasm as it induces relaxation allowing for improved chances of transanal retrieval and shorter operating time [1]. Only 10 cases required further procedures including colostomy and perforation repair, including the need for a conversion to a laparotomy. It appears the potential extent of injury is unbeknownst to the public [16]. Awareness and public education, including the appropriate and careful use of foreign bodies will assist in reducing the likelihood of these traumatic injuries occurring.
To our knowledge, there are no existing similar studies published in the Northern Territory. While this study represents the very first of its kind in the region, it is crucial to recognise the limitations of establishing significant correlations within this dataset due to there being a limited number of cases. Hence, the findings of the study should be approached with careful consideration. This leads to our recommendation of a review of the data in decades to come to help facilitate a larger sample size of cases and results, describing a more robust picture of anorectal trauma. The major limitation of small sample size in this study leaves what is a small picture that can be used in a clinical setting, and hopefully with further research this can be rectified.
In conclusion, this study serves to provide the epidemiological information and surgical implication on patients presenting to Northern Territory hospitals with anorectal trauma due to foreign bodies. Whilst there is an increasing acceptance for self-pleasure and increasing incidence of foreign body insertion, many patients remain hesitant to seek professional help. More severe surgical implications were associated with the delay in presentation of time. Our recommendation for bettering care of anorectal trauma is to encourage a healthy and safe clinical environment to help prevent stigma and facilitate earlier presentation to care from patients. Once a patient does present, our data shows that transanal extraction under general anaesthesia represents a very capable method of removing foreign bodies without exacerbating trauma. There is still evidence to suggest that there is a need for more awareness within health care professionals to ensure that patient-centred care is delivered, and with further research conducted with a larger sample size more distinct treatment for specific episodes can be elaborated on.
Ethics approval and consent to participate.
This is a case report that does not require a formal ethical committee approval in the Northern Territory of Australia.
Data is within the tertiary care centre Royal Darwin Hospital and requires a request of access to the centre.
The authors declare that they have no competing interests.
Funding statement.
This research was not funded.
Author contributions.
DTT – writing – original draft; investigation
JH – writing – original draft; investigation
RY – writing – original draft; investigation
AM - writing - review and editing; supervision
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
