Huge rectovesical fistula due to long-term retention of a rectal foreign body: A case report and review of the literature.

INTRODUCTION: Most patients with foreign bodies in their rectums present to medical institutions within a few days. In this report, we describe a foreign body in the rectum in situ for 5 months that resulted in a huge rectovesical fistula 4cm in diameter, requiring emergency laparotomy.

PRESENTATION OF CASE: A 59-year-old man, who had undergone rectal foreign body extraction via the anal canal without any complications 7 years previously, presented with abdominal pain and diarrhea. Computed tomography revealed a cup-shaped rectal foreign body and huge rectovesical fistula. We performed an emergency laparotomy. There was no contaminated ascites. The adhesion around the fistula was too stiff to be dissected. We incised the rectal wall, excised the ceramic cup-shaped foreign body, and detected a fistula approximately 4cm in diameter. We performed sigmoid colostomy, and the incised rectal wall and the bladder wall were sutured, and the residual rectum was supposed to function as a part of the bladder. After the surgery, no severe complications occurred. The patient told us that he inserted the foreign body himself 5 months earlier, and urine had appeared in the stool in the previous month.

DISCUSSION: A long-term retained rectal foreign body is very rare and could create an abnormal huge fistula between the pelvic organs because of prolonged pressure on the walls of the pelvic organs.

CONCLUSION: In patients with a long-term retained rectal foreign body, we should prepare for surgical treatment of not only the rectum but also the other pelvic organs.