Rectal foreign body
"Doctor, you won't believe this, but...."
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There is an elongated mechanical foreign object in the rectum and lower sigmoid colon. The sigmoid colon proximal to this is prominent, but is not abnormally dilated.
Extensive feces is seen in the remainder of the colon to the proximal large bowel. No evidence of bowel obstruction. No definite evidence of pneumoperitoneum on these supine films.
This case illustrates the benefits of orthogonal views... after all without the lateral view, this could be anywhere... right?
Case courtesy of Dr P. Phal.