A 14-year-old boy had been visited by a doctor due to the rectal insertion of a paintbrush, in which computed tomography (CT) of the abdomen was performed and demonstrated a 90 x 6 mm shaped object in the abdominopelvic cavity. He was referred to our hospital for further evaluation.
He reported a history of rectal insertion of a paintbrush four weeks ago, which resulted in rectorrhagia and pain during defecation since that time. The 4-week delay in seeking medical care was because of the patient's mortification. In physical examination, no fever, abdominal tenderness, or rebound was observed. In his CT image, the paintbrush was in the abdominopelvic cavity, located in the middle part of the lower abdomen. Oblique orientation of the FB was seen with the left tip pointing to the left lower abdomen and the right tip to the posterior of the lower abdomen, just anterior to sigmoid bowel loops. The location of the FB was reported in the mesenteric area with adjacent fat stranding and not in the bowel loops (Figure 1). However, the rectal examination was unremarkable. We performed another CT scan for reassurance and reevaluation, which had the same result in comparison to the first image. He underwent rigid sigmoidoscopy under general anesthesia, with no findings in the last 25 cm of the rectum and sigmoid colon. Subsequently, a colonoscopy was performed, which did not show any abnormality. Eventually, exploratory laparoscopy was performed.
The patient was taken to the operating room for general anesthesia and was placed in the supine position. Insufflation was done via the insertion of a Veress needle into the umbilicus. Then, a trocar was passed from the umbilicus for the laparoscope, and two laparoscopic graspers were passed from the abdominal wall, one in the right lower quadrant and the other in the left lower quadrant. The peritoneal cavity was explored, and the tip of the paintbrush was found. The paintbrush was covered with omentum, so dissection of the omentum was performed, and the paintbrush was taken entirely out by laparoscopic graspers (Figure 2). No other abnormal finding or intestinal damage was observed in the peritoneal cavity. Finally, the fascia and skin were closed layer by layer.
The patient received ceftriaxone (25 mg/kg/dose every 12 hours for two days) and metronidazole (10 mg/kg/dose every 8 hours for two days) postoperatively and was discharged in good condition three days after the surgery. The patient has been visited routinely at our clinic postoperatively, with no signs and symptoms presented. After three years from the operation, he is well without any complaints.