Rectal Impaction Following Enema with Concrete Mix

by Peter J. Stephens, M.D., and Mark L. Taff, M.D. from the American Journal of Forensic Medicine and Pathology 8(2):179-182, 1987.

This article describes an unusual rectal foreign body resulting from homosexual anal erotic activities. The patient had used an enema containing a concrete mix which became impacted and required surgical removal. The use, abuse, and complications of enemas are reviewed.

Key Words: Anal eroticism--Colorectal injuries--Enemas, cement--Foreign bodies--Paraphilias.

During the last 20 years, sexual habits have changed in western society. Both homosexuals and heterosexuals have shown an increasing interest in anal erotic practices, including the use of enemas for sexual enjoyment. We report a case of a klismaphiliac who had an impacted foreign body in his rectum followin an enema with a concrete mix.

CASE REPORT

A 20-year-old man presented to the emergency room complaining of rectal pain. A well-nourished, well-developed man without signs of intoxication was admitted in no apparent distress. Digital examination of the rectum revealed a stony hard mass. Abdominal plain films showed a vertically oriented, low-lying radiopaque object in the rectum. A spherical radiolucency was noted in the upper pole of the mass. A blood alcohol level was negative. No other drug testing was performed.

Upon further questioning, the patient said that approximately 4 hrs earlier he and his boyfriend had been "fooling around." After stirring a batch of concrete mix, the patient laid on his back with his feet against the wall at a 45-degree angle while his boyfriend poured the mixture through a funnel into his rectum. After the concrete mass hardened, it became so painful that he sought medical care.

Under general anesthesia, the anus was dilated and two Foley catheters were inserted alongside the rectal mass to relieve suction. A concrete case of the rectum was delivered without incident. The rectal mucosa was intact with a hyperemic and edematous appearance.

The patient was kept overnight and discharged uneventfully the following morning. The attending physician recommended a psychiatric consultation, but the patient declined.

PATHOLOGIC EXAMINATION

Examination of the specimen revealed a perfect concrete cast of the rectum, measuring 12 X 7 X 5 cm and weighing 275 g (Fig. 2). A thin layer of feces coated the surface and crevices. Grooves in the mass were consistent with rectal mucosal folds. A layer of concrete was chipped off the upper part of the specimen and revealed a white plastic ping-pong ball. This corresponded to the radiolucency observed in the abdominal x-ray.