Opacity in the pelvis.

CLINICAL PRESENTATION A 58-year-old man presented to the emergency department with a 3-day history of progressive abdominal pain, obstipation, difficulty in micturation and pain in the rectal area. He denied fever, hematuria, nausea or vomiting. He had no significant medical history and was on no regular medications. Physical examination revealed a well-nourished, hemodynamically stable man. Abdominal examination revealed mild lower abdominal tenderness, with no guarding and positive bowel sounds. Laboratory examination revealed a normal complete blood count with an unremarkable urinalysis. An abdominal radiograph showed a well-defined opacity over pelvic region (Figure 1). The patient admitted that he was HIV positive and 4 days before had let his friend place a pool ball in a condom inside his rectum. Multiple manual attempts to dislodge the ball, by the patient, had failed. Thus, he chose to seek out medical help. He further admitted of inserting and successfully removing other variety of objects from his rectum in the past. The ball was retrieved transanally using Chamberlain forceps under general anesthesia. A rigid sigmoidoscopy, subsequently performed, did not disclose laceration. Deliberate or accidental insertion of foreign bodies into the rectum is an infrequent clinical problem and poses a serious challenge to the involved clinicians. The vast majority of cases are a result of erotic activities.1 Patients tend to conceal the information, due to the fear of humiliation. They generally seek medical assistance after attempts of manually removing the object have failed.2 Colonic perforation is a feared complication. Plain abdominal radiographs are generally first line because they assist with localization of the foreign body and guide further management. Uncomplicated cases can be managed by digital transanal removal of the object. Endoscopic-guided techniques with a polypectomy snare may be used with objects above the rectosigmoid junction. Presence of perforation, very large objects and difficulty with above techniques all warrant a laparotomy.2