An intra-abdominal foreign body spontaneously excreted per rectum : a case Report

A 71-year-old female patient underwent an abdominal simple panhysterectomy with bilateral adnexectomy and received radiation therapy for carcinoma of the corpus uteri in January 2000. She began having repeated alternate episodes of diarrhea and constipation six months after the operation, and pain in the lower quadrants of the abdomen also developed. As the symptoms were persistent the patient was examined by colonoscopy in March 2002. The examination disclosed in the sigmoid colon the presence of a net-like foreign body partly embedded in the intestinal mucosa and unexcisable endoscopically. The foreign body was considered to be a Marlex mesh that had been applied to an area of peritoneal defect during a previous operation and probably perforated into the intestine. After two months, the foreign body was spontaneously excreted on bowel evacuation. While endoceliac foreign bodies, such as retained surgical gauze, sometimes form granulomas and are subjected to surgical extirpation, reports of spontaneous excretion of a foreign body perrectum have been as few as 3 cases in Japan, including the one documented herein. The underlying mechanism is assumed to be that the segment of intestine adhering to the periphery of the mesh became necrotized due to inflammation caused by radiation therapy, so that the mesh perforated into the colon and was gradually dragged into the intestinal lumen by peristalsis.