Endoscopic Removal of a Press-Through Pack from the Anal Canal

Abstract

The incidence of press-through pack (PTP) ingestion has been increasing. In many cases, the ingested PTP is lodged in the esophagus. Here, we report a case of endoscopic removal of a PTP from the anal canal. An 89-year-old man with mild dementia presented with a 3-day history of anal pain. On digital rectal examination, we felt a hard and sharp object, which could not be manually removed due to its shape. Therefore, it was removed endoscopically. We inserted an endoscope with a large-caliber soft oblique cap and observed the PTP in the anal canal. It was successfully removed using grasping forceps. The patient was stable, with only mild anal fissures, and no serious complications such as perforation and bleeding were observed. It is generally recognized that a PTP that reaches the large intestine is naturally expelled. Even if a PTP could pass through the pylorus or the small intestine, it could still be difficult to discharge naturally from the anus without discomfort or pain, as in this case.