a foreign body inside the anorectal tract is an intermittent situation a surgeon may encounter with a variety foreign bodies , input pathways , and clinical patterns . as a treatment , foreign body removal through a per - anum approach , a proctocolectomy or an enterostomy through a laparotomy might be necessary in cases where the foreign body can not be removed through the rectum or in cases with associated anorectal injury . we report one case of a rectal foreign body that was caused by the inattentive usage of a common instrument ; the foreign body was removed transanally . the patient was a 67-year - old male who had inserted a foreign body into his rectum 7 hours before the hospitalization at the emergency room ( er ) . he heard that a hemorrhoid could be improved if he used a massager to massage around the anal area . the patient massaged the perianal area with a massager to which differently shaped tips could be attached . the patient tried to remove the tip by himself , but came to the er after feeling the foreign body move inside . his past medical history showed a right hemicolectomy 2.5 years earlier because of ascending colon cancer . according to the pathologic results at that time , he was going through a periodic follow - up and did not have any other significant medical history . the patient did not have abdominal pain , but felt discomfort and minor pain around the perianal area . the patient 's vital signs were stable , with a pulse rate of 70 per minute , a respiratory rate of 12 per minute , a blood pressure of 130/80 mmhg , and a temperature of 36.5. according to the physical examination , the abdomen was soft and flat , the bowel sound was normal , and no abdominal pain was being experienced . upon digital rectal examination , the distal edge of the foreign body , which was located approximately 8 cm from the anal verge , was palpable . there were no blood , no tar - colored rectum discharge , and no foul odor . on a simple abdominal x - ray image , the foreign body was observed to be a radio - opaque object located in the pelvic cavity ( fig . 1 ) . according to the laboratory test , the white blood cell count was 10,440/l ( neutrophils , 84% ; normal range , 8,770/l ) , which showed an increase in white blood cell count and neutrophil count . there were no other abnormalities on the blood test . since there was a possibility of anal sphincter damage if the foreign body was removed at the er , removal after anesthesia was decided upon . after spinal anesthesia , a digital rectal examination was done in the lithotomy position . unlike the first digital rectal examination in the er , the object moving a bit distally was located 5 - 6 cm from the anal verge . with careful palpation so as not to move the object inside , a hole could be felt in the center of the foreign body , and a kelly forcep was used to hold the object and to remove it from the rectum ( fig . the surgery was finished after using anoscopy to check for mucosal damage on the distal rectum and the anal canal . the removed foreign body was a gray - colored hard - rubber - based object which was 7 cm long and 3 m in diameter ( fig . 3 ) . after making sure that there were no anal bleeding and no abnormality on the physical examination of the abdomen for 24 hours a foreign body inside the anorectal area has various causes , and the treatment method is selected based on the cause , the symptoms , and the severity of anorectal damage [ 1 - 3 ] . peroral foreign bodies are usually animal bones , fish bones , fish hooks , or tooth picks that have been swallowed by patients who are inattentive or drunken . in patients with mental illnesses , numerous unexpected foreign bodies are reported [ 1 , 2 ] . in cases where the foreign body was inserted through the anus , a sexual purpose is reported to be the most common cause [ 2 , 4 - 7 ] . some references even reported that more than 50% of the cases were caused by insertion for sexual purposes [ 6 , 7 ] . the types of foreign bodies inserted through the rectum are very diverse , and numerous references reported these different kinds of objects : for example , vegetables ( cucumbers or eggplants ) , light bulbs , glass bottles , liquor shot glasses , water glasses , pistols , candles , toothbrushes , portable heaters , soda cans , shoehorns , brooms , umbrellas , rocks , magazines , thermometers , sex toys , vibrators and so on [ 1 - 3 , 6 - 10 ] . there are regional differences . in eastern countries , including korea and japan , where raw fish and grilled fish are often consumed , the rate of perorally - inserted foreign bodies is reported to be high . however , in western countries , foreign - body insertion through the anus for sexual pleasure is more common [ 1 , 4 , 10 ] . in most cases , it is known that approximately 74% of the patients can be treated in the er ; ie , the foreign body can be removed transanally in the er . however , if the patients do not cooperate due to discomfort or pain during the procedure , repetitive attempts to removing the foreign body may be necessary . this might result in the object being shifted deeper into the anal canal or in anal sphincter damage . in such cases , it is better to approach per anum after anesthesia rather than continuing the repetitive attempts to remove the object . in cases where the foreign body is very large or complications ( rectal perforation or peritonitis ) are found , a proctocolectomy or an enterostomy through a laparotomy might be necessary [ 1 , 4 ] . in patients such as the one in this case report where the foreign body is located lower than the rectosigmoid junction , this relaxes the pelvic floor muscle and allows the patient to increase the abdominal pressure at the appropriate moment , which helps move the foreign body towards the anus . in addition , the lithotomy position is preferred when surgically removing a foreign body because when the foreign body is located in the upper or mid rectum , using gravity to guide the object along a line parallel to the sacral curve is easier in the lithotomy position than in the jackknife prone position or the left lateral position . after removal of the foreign body , the patient should be observed for 1 or 2 days in case of complications such as delayed damage caused by the foreign body [ 6 , 9 , 12 ] . after experiencing this case , we collected brief information about massagers . about 20 different massagers from 15 or more producers are on sale according to our internet web search . five of them were manufactured to accommodate differently - shaped alterable heads to support a more effective massage to different parts of the human body on instruction . the tip of the massager that this patient had used was included in two kinds of massagers that were on sale . this case report shows that users of massagers need to pay close attention to the dangers associated with inattentive usage .
a male , 67 years old , visited the emergency room because of a foreign body impacted in his rectum . while he was being treated for grade - ii hemorrhoids 
 conservatively , he heard that massage of the peri - anal area could be helpful for preventing hemorrhoids . 
 thus , while using an electronic massager after placing the head of the machine into a short round bar , the head became separated from the machine , and this was inserted into the anus and impacted . 
 the patient had anal discomfort without abdominal pain . 
 his vital signs were stable , and no abnormal physical findings were found for the abdomen . on digital rectal examination , 
 the rim of the foreign body was palpated about 8 cm from the anal verge . 
 anal bleeding , abnormal discharge , or foul odor was not found . on a simple abdominal x - ray 
 , a radio - opaque foreign body was observed in the pelvic cavity , and mild leukocytosis was noted on the laboratory test . to avoid injury to the anal sphincter 
 , we tried to remove the foreign body under the spinal anesthesia . 
 after anesthesia had been administered , the foreign body was palpated more distally at 5 - 6 cm from the anal verge by digital examination , and the foreign body was found to have a hole in its center . 
 this was held using a kelly clamp , and with digital guiding , was removed through the anus . 
 after removal , an anoscopic examination was performed to determine if mucosal injury had occurred in the rectum or anal canal . 
 the patient was discharged without complication after 24 hours of close observation .