Vibrator-induced fatal rectal perforation

A middle-aged man was admitted to our hospital with abdominal pain and bleeding per rectum. Subsequent laparotomy indicated an established faecal peritonitis in relation to an anterior perforation of the upper rectum. He later volunteered that he had anal intercourse 2 days previously with a vibrator at an erotic party. His partner volunteered further information regarding devient practice such as regular insertion of other foreign objects (e.g. shower hose). Tearing of the rectal mucosa following such practices is a recognised complication. However mortality following foreign body perforation is reported as extremely rare in the medical literature. Surgical repair of rectal perforation and intensive treatment did not prevent development of acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) hence leading to multiple organ dysfunction syndrome (MODS) and death. This case report highlights the seriousness of rectal injuries following unusual sexual practices. Death in this case can be attributed to the late presentation and established faecal peritonitis. Death due to retroperitoneal perforation following such accidents have been reported in the literature. However previously no cases have been recorded where death occurred due to anterior rectal wall perforation.