LETTER TO THE EDITOR Throw a bone here: an evil and rare consequence of foreign body passage Marco Silva 1 & Andreia Albuquerque 1 & Frederica Gonçalves 2 & Guilherme Macedo 1 Accepted: 3 February 2016 # Springer-Verlag Berlin Heidelberg 2016 Dear Editor: The authors report a case of a 54-year-old woman who was admitted in the emergency department due to severe anal pain. She referred that this pain started after she had eaten chicken bones 4 days before. She also complained of obstructed defe- cation and the presence of small hard bones in the stools. The perianal area was ulcerated and very painful. On digital examination, small bones were palpable in the stools. No signs of perforation were found on the plain abdominal radiograph. A proctosigmoidoscopy showed stools with multiple small bone fragments in the rectum (Fig. 1) and signs of ischemia of the distal rectum and anal canal mucosa due to the previous impaction of these fragments (Fig. 2a, b). Some large bones were removed during proctosigmoidoscopy, but it was impos- sible to remove all. The patient was admitted in the surgical ward, and symp- toms progressively improved, with subsequent mucosa healing and passage of the bones in the stools. She was discharged 5 days later. Rectal foreign bodies often represent a difficult diagnostic and management dilemma. Although the majority is inserted through the anal canal, in rare cases, it results from an orally ingested object that becomes impacted in the rectum [1]. Patients may be asymptomatic or present with abdominal pain, rectal bleeding or pain, and constipation. Though most objects pass without incident, complications can arise follow- ing ingestion of foreign body. Ischemia of the rectum is very rare due to its extensive collateral blood supply, but hard ob- jects pressing constantly against a particular area of the bowel wall may decrease the capillary perfusion pressure and, if prolonged, it may induce ischemic lesions [2]. Fig. 1 Proctosigmoidoscopy image showing stools with multiple small bone fragments in the rectum Electronic supplementary material The online version of this article (doi:10.1007/s00384-016-2535-4) contains supplementary material, which is available to authorized users. * Marco Silva marcocostasilva87@gmail.com 1 Department of Gastroenterology, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal 2 Department of General Surgery, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal Int J Colorectal Dis DOI 10.1007/s00384-016-2535-4