Rectal foreign body of a shattered glass bottle; Case report of unexpected late post-operative hemorrhage managed transanally.

INTRODUCTION: Retained rectal foreign bodies are commonly implicated in patients engaging in erotic behavior. The foreign bodies vary widely, however, penetrating rectal wounds are uncommon and often complicate the retrieval of the object. The rich vascular bed of the rectal mucosa provides additional bleeding complications. PRESENTATION OF CASE: A 55-year-old male presented with active bleeding after intentional insertion of a glass bottle into the rectum which shattered. Partial retrieval via proctoscopy was followed by an exploratory laparotomy with a diverting colostomy, mucous fistula, and presacral drainage. Postoperative course was complicated by severe hematochezia. Colonoscopy was performed in the operating room found actively bleeding ulcers at sites of previously lacerated mucosa; one pulsating, protruding, vessel was visible. Clips were placed over the vessel with cessation of bleeding. Barium enema at three months follow revealed no leaks allowing for reversal of the colostomy. DISCUSSION: This case of operative retrieval of a rectal foreign body is unique because it displays deviation from commonly used algorithms are periodically needed to optimize patient recover. CONCLUSION: The utilization of minimally-invasive colonoscopy prior to additional surgical intervention in post-operative rectal bleeding following a rectal foreign body retrieval may improvie patient recovery time, functionality, and long-term outcomes.

Effect on nurse and patient experience: overnight use of blue-depleted illumination.

BACKGROUND: Typical hospital lighting is rich in blue-wavelength emission, which can create unwanted circadian disruption in patients when exposed at night. Despite a growing body of evidence regarding the effects of poor sleep on health outcomes, physiologically neutral technologies have not been widely implemented in the US healthcare system. OBJECTIVE: The authors sought to determine if rechargeable, proximity-sensing, blue-depleted lighting pods that provide wireless task lighting can make overnight hospital care more efficient for providers and less disruptive to patients. DESIGN: Non-randomised, controlled interventional trial in an intermediate-acuity unit at a large urban medical centre. METHODS: Night-time healthcare providers abstained from turning on overhead patient room lighting in favour of a physiologically neutral lighting device. 33 nurses caring for patients on that unit were surveyed after each shift. 21 patients were evaluated after two nights with standard-of-care light and after two nights with lighting intervention. RESULTS: Providers reported a satisfaction score of 8 out of 10, with 82% responding that the lighting pods provided adequate lighting for overnight care tasks. Among patients, a median 2-point improvement on the Hospital Anxiety and Depression Scale was reported. CONCLUSION AND RELEVANCE: The authors noted improved caregiver satisfaction and decreased patient anxiety by using a blue-depleted automated task-lighting alternative to overhead room lights. Larger studies are needed to determine the impact of these lighting devices on sleep measures and patient health outcomes like delirium. With the shift to patient-centred financial incentives and emphasis on patient experience, this study points to the feasibility of a physiologically targeted solution for overnight task lighting in healthcare environments.