A Leak In The Safe

A 35-year-old man presented to the emergency department with profuse rectal bleeding, abdominal pain and an altered mental status. On physical examination, he was found to be intoxicated, with a blood pressure of 70/40 mm Hg, a pulse of 110 beats per minute, and an oxygen saturation of 90%. Abdominal examination revealed a mass and the presence of peritoneal signs. There was no evidence of trauma. A foreign body was found on rectal examination but was not visible. Once the patient was hemodynamically stable, plain-film radiography of the abdomen was performed, and an intact bottle was seen in the rectosigmold colon. Laparotomy revealed a glass bottle of beer lodged in the sigmoid colon, with multiple lacerations in the rectosigmold colon. The bottle was extracted, and Hartmann’s colostomy was performed. The patient was treated with broad-spectrum antibiotics and anagesics and underwent colorectal reanastomosis, after which the recovery was uneventful.

— Roberto Flores-Suares, M.D.

Jorge Reyes-del Valle, M.D., Ph.D.

The New England Journal of Medicine 10/28/10