An Imperfect End

This is a post of an Emergency Room Doctor
An imperfect end
Posted by GruntDoc on August 4th, 2007
Frankly, this is a bit gross. I’ll put the post below the fold, and read at your own risk. You’ve been warned.

Removal of a rectal foreign body is simple, really: Locate it, grasp it firmly, break the ’suction’, and pull. Seems simple, and like most seemingly simple tasks it’s harder to accomplish in real life.

The patient of a colleague had just such a complaint, and I willingly agreed to help remove the object, which we had an x-ray of, a common vibrator. On delegation of tasks my colleague would be in charge of the patients’ sedation, and I was on removal duty.
I had all I needed, a plastic and lit vaginal speculum, ring forceps, some nice plastic tubing (for suction relief), and lube.
The patient was suitably sedated, and it was time to proceed. The speculum was inserted, and no foreign body was visible until the anterior abdomen was compressed, and !viola!, it appeared. I saw a small area of man made black color, and the unmistakable edge of a condom on its edge. I carefully grabbed the rim of the condom (at the near-limit of the reach of the ring forceps, probably 8 inches in) and began to hopefully tug.

Hope may well float but condoms just break, and when they do they recoil in both directions with fervor and throw-off anything attached. In this case I protected the team by taking the hit squarely in the face. (This has become something of a topic of conversation in my ED).
No, I wasn’t wearing protection beyond beyond my usual spectacles. I did try another two times to grasp the end of the vibrator with the ring forceps, but could never get enough of a hold to even attempt to break the suction (due to the tapered design of the end of the vibrator) (which design I learned from reading the Internet).

In retrospect, a tenaculum might have allowed a better grip on the vibrator, but given our thorough attempts the surgeon on call took the patient in and the object out.
I washed my face at the sink for a nice, long time, and have thought about getting a tenaculum prior to the next time. Oh, and one of those face mask-shield things.

My comment:
Was the patient in some sort of serious pain? Was there some sort of impaction of feces, immovable obstruction, or other circumstance that posed some dangers? If not, I'm wondering if perhaps giving her instructions to try eating three or four bananas with a few bowls of all bran or oatmeal might be worth a try. From your description of the rambling device, there was no real impediment to it making a normal exit on its' own, particularly if you could apply some lubrication and perhaps even turn the device on.

And I ended it there. Did I play nice or what? Know what happened? My comment got stuck in a spam filter. Is that strange?

Anybody have any notion what the costs might have been? Must be a few grand anyway. Ooops. No, a lot more. They brought in the surgeon. It would have been a few grand if she had expelled it while the ER doctor watched and grabbed it at the end. Sure wish I knew what sort of surgery was performed. I do hope the poor lady is all right. With any luck at all it's just an unobtrusive scar, like an epesiotomy. Who knows? Maybe the surgeon did a tiny tune up while he was at it. What's the tab on that? Let's say in round numbers, $5000. I really don't have any idea. Leave that aside. A trifle.

What about the risk of post-operative infection? There must be some logical reason, some piece of essential information I have missed, that absolutely forced these doctors to cut her open right away in the area with the highest number of potentially pathogenic organisms in the body, instead of allowing nature to take its' course. Here is another question. That Xray. Is it possible that this young lady was unaware that it was a vibrator up there? Was she somehow incapable of describing it? And if so, why on Earth was the Xray needed? Ah, medicine is such a mystery.