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Indian Journal of Surgery, Vol. 68, No. 6, November-December, 2006, pp. 336 Letter To Editor Is rectal lubrication the key to non surgical removal of rectal foreign bodies? Sharma Hemant, Sharma Abhishek Department of Surgery, Frenchay Hospital, Bristol BS16 1LE Code Number: is06099 Related Article: is06061 Sir, We read the Case Report of Dr. Bhanot et al ,[1] with great interest. The paper highlighted the adjunct use of laparoscopy but we are concerned that the authors have not emphasized the importance of rectal lubrication for removal of foreign bodies of rectum (FBR). In our understanding, if rectal lubrication is used in ample amounts, it can make nonoperative FBR removal more successful. We would like to present our view in this aspect. Blocki et al[2] had hypothesized the development of proximity forces on interaction of two objects/surfaces. In our understanding these are the forces that come into play on contact of FBR and rectal mucosa. The subsequent vigorous defecatory attempts by the patient accentuate the van der wall forces between the two surfaces and also create a negative intraluminal pressure. This results into impaction and difficult removal. Physicists have proved that dynamic wetting of surfaces (lubrication) creates a kinetic slip by decreasing intermolecular interactions.[3] Similarly physiologically in lungs, surfactant facilitates decrease in surface tension and glycoproteins assist free chest movement by providing ample lubrication.[4],[5] This in simple terms may be interpreted as slipping of body membranes. If these concepts are applied for FBR removal, we opine that rectal lubrication should provide decrease in intersurface forces between rectal foreign body and mucosa, creating a slip on manual abdominal pressure and defecatory efforts thus making removal of FBR easy by nonoperative means. References
Copyright 2006 - Indian Journal of Surgery |
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