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Rectal Impaction Following Enema with Concrete Mix
by Peter J. Stephens, M.D., and Mark L. Taff, M.D.
from the American Journal of Forensic Medicine and Pathology
8(2):179-182, 1987.
This article describes an unusual rectal foreign body resulting
from homosexual anal erotic activities. The patient had used an enema
containing a concrete mix which became impacted and required surgical
removal. The use, abuse, and complications of enemas are reviewed.
Key Words: Anal eroticism--Colorectal injuries--Enemas, cement--Foreign
bodies--Paraphilias.
During the last 20 years, sexual habits have changed in western
society. Both homosexuals and heterosexuals have shown an increasing
interest in anal erotic practices, including the use of enemas for
sexual enjoyment. We report a case of a klismaphiliac who had an
impacted foreign body in his rectum followin an enema with a concrete mix.
CASE REPORT
A 20-year-old 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. A
spherical radiolucency was noted in the upper pole of the mass. A
blood alcohol level was negative. No other drug testing was performed.
Upon further questioning, the patient said that approximately 4
hrs 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-degree 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 case 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.
PATHOLOGIC EXAMINATION
Examination of the specimen revealed a perfect concrete cast of
the rectum, measuring 12 X 7 X 5 cm and weighing 275 g (Fig. 2). A
thin layer of feces coated the surface and crevices. Grooves in the
mass were consistent with rectal mucosal folds. A layer of concrete
was chipped off the upper part of the specimen and revealed a white
plastic ping-pong ball. This corresponded to the radiolucency observed
in the abdominal x-ray.
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