Rectal foreign bodies are common and various shapes and sizes have been described in literature. Large objects impacted high in the rectosigmoid junction pose a challenge for endoscopic extraction. We describe a method that successfully removed a 15x6x3.5-cm shampoo bottle impacted in the rectosigmoid junction. A 50-year-old man had passed a shampoo bottle up into his rectum. Examination revealed a lax sphincter but the bottle could not be felt. Contrast x-rays showed a well-delineated bottle in the rectosigmoid junction with no evidence of bowel perforation. A flexible sigmoidoscope with an endoscopic snare was used to "lasso" the foreign body and deliver it out. A check sigmoidoscopy after extraction showed no bleeding or perforation. This technique is a safer and less morbid method of extracting impacted high rectal foreign bodies, in the absence of perforation. It should be attempted before open surgical removal.
It is essential for clinicians performing bedside ultrasound thyroid and guided FNAC to document their sonographic impression of the nodule in an objective fashion using the TIRADS classification and correlate with the gold standard cytology to improve their learning curve and audit their results.
Adrenal lipomas are rare, non-functioning benign tumours, which are primarily detected during autopsy or imaging, as asymptomatic incidentalomas. Occasionally, they can present with abdominal pain due to their large size. Imaging studies help to determine the origin, volume, composition of the lesion and presence of bleeding. Histopathology, however, is necessary to differentiate an adrenal lipoma from other fatty tumours such as myelolipoma, angiomyolipomas, teratomas and liposarcomas. We report a case of spontaneous bleeding from a giant adrenal lipoma that presented as an acute abdomen, and was initially mistaken on imaging for the more common myelolipoma. The literature is reviewed to discuss the clinical, pathological and radiological features, and the optimum therapeutic management.
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