Deodorant aerosol spray can in the rectum: a potential fire hazard during surgery

Abstract

Rectal foreign bodies are not uncommon and often pose a serious challenge to surgeons. In majority, the objects are inserted by self in children, psychiatric patients and for sexual gratification in adults. Various rectal foreign bodies have been reported. Deodorant aerosol spray can in the rectum has not been reported previously. Danger of aerosol dispenser can is the risk of fire and explosion. Especially during any surgical procedures to remove the foreign body using cautery or any energy devices. We report of a rare foreign body of deodorant aerosol spray can in the rectum in a young male patient, which was removed under general anaesthesia.

Background

Various types of rectal foreign body (RFB) have been described in the literatures.^1–3 Deodorant aerosol spray cans in the rectum are very rare.² Deodorant aerosol spray dispenser system creates an aerosol mist of perfume payload along with propellant under intense pressure. The propellants in deodorant aerosol cans are typically combinations of ignitable gases, which can cause fires and explosions. So it is very risky inside the rectum, especially during surgery when using cautery or any sharp instruments, which can cause fire and explosions.

Diagnosis of RFB can be made with plain radiograph. On presentation, it is important to rule out signs and symptoms of peritonitis. The management of RFB is challenging in regards to determining the method of extraction or the need for surgery.^1–4 An attempt at bedside retrieval of foreign body is an accepted strategy. If unsuccessful, examination under anaesthesia followed by trial of removal of foreign body should be done. Operative intervention should be the last resort after all methods have been exhausted.^2–4

Case presentation

A 21-year-old man presented to the surgical emergency with alleged history of insertion of an aerosolised deodorant spray can in his rectum by two unknown people. He was allegedly under the influence of alcohol at the time of incident. He could not give the exact detail of the incident. He presented with complaint of pain in abdomen for 1 day. He was conscious, cooperative. There were no signs and symptoms of peritonitis. On per rectal examination, anus was patulous and the foreign body could be palpated just at the tip of the index finger.

Investigations

On plain abdominal radiograph, there was no free air under diaphragm and the retained foreign body in rectum was identified (figure 1). Haemogram and serum biochemical workup were unremarkable.

Figure 1.

Plain abdominal radiograph showing a large retained rectal foreign body (deodorant spray dispenser can—yellow arrow).

Treatment

After unsuccessful attempt to remove the RFB in the bedsides, he was taken up for emergency surgery under general anaesthesia with a plan of trans anal extraction and laparotomy if needed. Lithotomy position was made and pressure was applied per abdominally and the foreign body was removed successfully trans anal (figure 2A, B).

Figure 2.

(A) Trans anal extraction of deodorant spray dispenser can under general anaesthesia. (B) Extracted deodorant spray dispenser can.

Outcome and Follow-up

The postoperative period was uneventful. Psychiatric evaluation and counselling was done. He is doing well in follow-up.

Discussion

RFBs usually are inserted with the vast majority for self-gratification for anal eroticism.^1–3 Other causes include body-packing, attention seeking behaviour, accident, assault and rarely impacted ingested foreign body.^1–3 These are more common in men than women. The foreign bodies reported ranges from plastic bottles, wooden objects, bulbs, vibrators and drinking glass.^1–4 Deodorant aerosolised spray can is a very rare RFB.²

History and examination including both abdominal and digital rectal examination is required for accurate diagnosis and to rule out signs of peritonitis. Plain abdominal radiograph is the initial investigation in all patients, which provides the type of foreign body, its location or presence of free air as a sign of perforation.

On all patients bedside trans anal extraction should be attempted. When unsuccessful, trans anal extraction should be attempted in the operating room under anaesthesia with full relaxation of anal sphincter with transabdominal manipulation.^2–4 Various surgical techniques have been described for RFB retrieval ranging from laparoscopic-assisted removal to laparotomy.^2–4

The main problem with aerosolised spray cans in the rectum as in our index case is that there is a real concern of fire and explosion during surgery. Many scientists consider them inherently hazardous in terms of combustion and explosions. Deodorant aerosol spray dispenser system creates an aerosol mist of perfume payload along with propellant under intense pressure. The propellants in deodorant aerosol cans are typically combinations of ignitable gases. The propellants used are mainly hydrocarbons like butane and propane, which are very inflammable. In fact, they are considered and marked as inflammable product by the manufacturing companies and are prominently displayed in the can label. So it is very risky inside the rectum, especially during surgery when using cautery or any sharp instruments, which can cause fire and explosions. Deodorant aerosol spray RFB has been reported in the literature.² But it failed to incorporate the role of deodorant aerosol spray as a potential source of fire in the operating room during surgery. We kept that risk in mind before shifting the patient to the operating room and gave a trial of evacuation under anaesthesia before surgical removal, which was successful. We could not find any reports describing deodorant aerosol spray as a potential cause of fire and explosion during surgery.

Intraoperative fires during emergency colonic surgery have been well reported.^5–7 Oxygen source, fuel source and ignition mechanisms are required to start a fire. Gastrointestinal gases, which contain high concentrations of hydrogen and methane, act as a fuel for fire.^5–7 Obstruction in gastrointestinal tract causes stasis and increased production of flammable gas by metabolism of bacteria. Caution must be taken while using diathermy in this setting as these gases can act as a fuel source, leading to gas explosion and fire. It becomes more hazardous in the presence of an aerosolised deodorant can with inflammable gases in the rectum as in this indexed case. So in this situation, colons should be entered mechanically using scalpel and cautery should be used cautiously or better avoided. After successful extraction, patients should be observed to exclude for rectal perforation. Anal incontinence may be rare but a potential complication after retrieval. Psychological assessment and counselling is required in all patients.

In conclusion, deodorant aerosol spray cans are rare and hazardous RFB. There is a real risk of fire and explosions during surgery. During surgery all precaution to avoid or minimise the use of cautery and energy devices should be made.

Learning points.

• Management of rectal foreign body is a challenge to surgeons.

• Efforts to accurately diagnose the type of foreign body should be made.

• Aerosolized deodorant spray can is a fire and explosion hazards due to the compressed gas used for propulsion of deodorant mist.

• During surgery minimize the use of energy sources including cautery.

• Proper psychological counseling and help should be provided to the patients in the follow-up.