Rectal Foreign Body Removal

Rectal Foreign Body Removal

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Anorectal foreign bodies are usually inserted transanally for sexual or medicinal purposes. Rectal foreign bodies may also be observed with body packing or stuffing or after previous oral ingestion of the object. Anorectal foreign bodies are more common in men than in women.

Rectal foreign bodies may include such objects as bottles, vibrators, fruit, vegetables, and balls. Cylindrical objects are common. In addition, thermometers may accidentally break while a rectal temperature is being obtained.

The clinician should be aware that patients have usually made multiple attempts to remove the object before presentation in the emergency department (ED). Patients may create unusual stories to explain how the object became lodged in the rectum. Assault must be considered as a possible etiology for an anorectal foreign body.

See Foreign Bodies: Curious Findings, a Critical Images slideshow, to help identify various foreign objects and determine appropriate interventions and treatment options.

Indications for bedside rectal foreign body removal in the ED include the following:

Prompt removal is advisable. [1, 2, 3]  Delayed removal of rectal foreign bodies can lead to severe complications, including the following:

Absolute contraindications for bedside rectal foreign body removal in the ED include the following:

Relative contraindications for bedside rectal foreign body removal in the ED include the following:

The rectum lies in the sacrococcygeal hollow and changes to the anal canal at the puborectal sling formed by the innermost fibers of the levator ani. It has a dilated middle part called the ampulla. (See Large Intestine Anatomy and Anal Canal Anatomy.)

The rectum is related anteriorly to the urinary bladder, prostate, seminal vesicles, and urethra in males and to the uterus, cervix, and vagina in females. Anterior to the rectum is the rectovesical pouch in males and the rectouterine pouch in females. The anal canal is related to the perineal body in front and the anococcygeal body behind; both of these are fibromuscular structures.

Coates WC. Anorectal procedures. Roberts JR, Custalow CB, Thomsen TW, et al, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia: Elsevier Saunders; 2013. 880-92.

Hellinger MD. Anal trauma and foreign bodies. Surg Clin North Am. 2002 Dec. 82(6):1253-60. [Medline].

Coates WC. Disorders of the anorectum. Walls RM, Hockberger RS, Gausche-Hill M, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia: Elsevier; 2017. 1166-1178.

Rodriguez-Hermosa JI, Codina-Cazador A, Ruiz B, Sirvent JM, Roig J, Farres R. Management of foreign bodies in the rectum. Colorectal Dis. 2007 Jul. 9(6):543-8. [Medline].

Rodrigues FG, Campos JB, Silva GD, Wexner SD. Endoscopic ultrasound in the diagnosis of foreign bodies of the colon and rectum. Rev Assoc Med Bras (1992). 2016 Dec. 62 (9):818-821. [Medline]. [Full Text].

Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart RW Jr. Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum. 2004 Oct. 47(10):1694-8. [Medline].

Han HJ, Joung SY, Park SH, Min BW, Um JW. Transanal rectal foreign body removal using a SILS port. Surg Laparosc Endosc Percutan Tech. 2012 Jun. 22(3):e157-8. [Medline].

Elias B, Debs T, Hage S, Bassile B, Hanna P, Saint Eve P. Single incision laparoscopic surgery technique for transanal removal of rectal foreign body. J Surg Case Rep. 2014 Mar 20. 2014(3):[Medline]. [Full Text].

Koornstra JJ, Weersma RK. Management of rectal foreign bodies: description of a new technique and clinical practice guidelines. World J Gastroenterol. 2008 Jul 21. 14(27):4403-6. [Medline].

Victoria L Hogan, MD Assistant Professor, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine

Victoria L Hogan, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Andrew R Edwards, MD, FACEP Associate Professor of Emergency Medicine, Vice-Chair for Education and Residency Program Director, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine; Medical Director, Jefferson County SWAT Team, Jefferson County Sheriff’s Department

Andrew R Edwards, MD, FACEP is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Rectal Foreign Body Removal

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