# Unintentional Retention of Rectal Foreign Body Associated With Autoerotic Practices: A Case Report

## TL;DR

A man accidentally retained a sweet lime in his rectum during autoerotic activity and required surgical removal.

## Contribution

This case highlights the management challenges and importance of psychiatric care in rectal foreign body cases.

## Key findings

- A 7 × 7 cm sweet lime was successfully removed via proctoscopic incision and extraction.
- The patient had no signs of perforation or peritonitis, but required sedation and anal block for removal.
- Psychiatric assessment and counseling were essential for postoperative care and follow-up.

## Abstract

Rectal foreign bodies (RFBs) are now an increasing presentation in the emergency rooms. While they most often result from insertion for sexual gratification, other causes, such as body packing and criminal or accidental insertion, can also occur. Various foreign objects of different shapes, sizes, textures, and materials are encountered, sometimes with impaction, perforation, and peritonitis. Other challenges include delayed presentation and reluctance to provide required details due to social stigma. In our case, the patient presented with abdominopelvic pain and obstipation. Upon further questioning, he admitted inserting a sweet lime fruit with sexual intent on the previous day. Digital rectal examination revealed a hard, round mass measuring 7 × 7 cm, located 4 cm from the anal verge. There were no signs of perforation or peritonitis; an X-ray confirmed the same. Since the anal sphincter was lax, a transanal extraction was attempted at the emergency room. The patient was anxious and failed to relax his anal sphincter completely. Hence, he was taken to the operating room. Under intravenous sedation and perianal block, a well-lubricated proctoscope was introduced, and a foreign body was incised to facilitate the grasping of the outer peel. The foreign body was then removed in pieces with ease. Postoperative proctosigmoidoscopy was normal, and the patient was discharged after psychiatric assessment and counseling. Hence, a systematic approach is recommended in diagnosing and managing RFBs. Psychiatric assessment and follow-up are also crucial in these patients.