PMC4405213_01
Plain radiographs of the pelvis outline a foreign body within the rectum (indicated by red arrow) that has a cylindrical shape and a tapered tip.
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fig1
A plain radiograph of the pelvis was ordered as a part of the trauma series and revealed an unexpected finding: a cylindrical object with a tapered tip and radiolucent hollow base was present within the rectum (Figure 1).
A photograph of the perineum. The patient is in lithotomy position and surgical drapes are applied. A 12 mm laparoscopic trocar is inserted into the anus and the trocar sleeve is fully advanced until the adjustable sleeve hub was pressed against the anus, creating a seal. A straight 35 mm laparoscopic grasper can be seen sliding beside the optical trocar into the anus. The seal is maintained by pressure from the anal sphincter.
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fig2
The trocar sleeve was advanced fully until the adjustable sleeve hub was pressed against the anus, creating a seal (Figure 2). In an attempt to retrieve the CFB, two 35 mm straight laparoscopic graspers were slid beside the optical trocar into the anus (Figure 2).
The cigar sheath is visualized in the sigmoid colon and is oriented such that the open base is firmly apposed to the sigmoid mucosa, creating a vacuum effect.
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fig3
It was oriented such that its base faced distally with the open rim firmly apposed to the sigmoid mucosa by vacuum effect (Figure 3).
In order to retrieve the object, a straight 35 mm laparoscopic grasper was introduced into the lumen and advanced under laparoscopic vision (arrow) in order to avoid iatrogenic injury to the mucosa.
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fig4
In order to prevent iatrogenic injury, we navigated the laparoscopic graspers into the sigmoid under laparoscopic vision (Figure 4).
The instruments have been used to manipulate the cigar sheath and to overcome the vacuum effect. The dislodged cigar case has been rotated within the lumen so that the rim now faces the laparoscope.
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fig5
This allowed the cigar case to be rotated within the colonic lumen so that the rim now faced the laparoscope (Figure 5).
Laparoscopic graspers were used to grasp the rim of the cigar sheath and extract it under laparoscopic vision.
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fig6
The laparoscopic graspers were used to grasp the rim of the cigar sheath and the CFB was extracted under vision (Figure 6).