Rectal Foreign Bodies
Section snippets
Epidemiology
Although retained rectal foreign bodies have been reported in patients of all ages, genders, and ethnicities, more than two-thirds of patients with rectal bodies are men in their 30s and 40s, and patients as old as 90 years were also reported.1, 2, 3 The literature is replete with single-center case studies because this is generally a rare problem that does not lend itself to a systematic or prospective analysis (Table 1). A report from one major teaching hospital spanning a 10-year period
Classification
Although the American Association for the Surgery of Trauma (AAST) rectal organ injury scale is generally used for blunt and penetrating trauma, its use for injury secondary to rectal foreign bodies is appropriate (Table 2). The treatment of all rectal injuries depends on the degree of injury, which is classified according to presence of hematoma, the percent circumference laceration, and whether or not there is devascularization of the rectum and perforation/extension into the perineum.5
History and Physical Examination
Patients with rectal foreign bodies are embarrassed and often reluctant to state the true nature of their emergency room visit. As a result, they may present with a chief complaint of rectal pain or abdominal pain, bright red blood per rectum, inability to have a bowel movement, and rectal mucous leakage. In most cases, patients present several hours to days after the placement of the rectal foreign body, and on occasion, the foreign body has even been successfully removed but the patient has
Transanal Approach
When attempting to remove a rectal foreign body transanally, the most important factor in successful extraction is patient relaxation. This can be achieved with a perianal nerve block, a spinal anesthetic, or either of these in combination with intravenous conscious sedation. All of these techniques allow the patient to relax, decrease anal sphincter spasm, and improve visualization and exposure. In general, a perianal nerve block similar to that used for anorectal surgery works quite well. The
Postremoval management and complications
The most dangerous complication of a rectal foreign body is perforation. When patients present with a rectal perforation, they should at first be stabilized like any trauma patient. After stabilization, management depends on 3 factors: first, whether the patient is clinically stable or unstable, second, whether the perforation is in an intraperitoneal or extraperitoneal location, and last, whether there is significant fecal soilage or not. A good rule of thumb is to manage a rectal perforation
Summary
Rectal foreign bodies present a difficult diagnostic and management dilemma. This is often because of the delayed presentation, wide variety of objects that cause the damage, and the wide spectrum of injury patterns that range from minimal extraperitoneal mucosal injury to free intraperitoneal perforation, sepsis, and even death. The evaluation of the patient with a rectal foreign body needs to progress in an orderly fashion, with appropriate examination, laboratory and radiographic evaluation,
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Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021
2023, American Journal of Emergency MedicineForeign bodies in the rectum: Three case reports of sexual violence
2022, Annals of Medicine and SurgeryCitation Excerpt :A variety of objects have been reported in the literature. Two-thirds of the patients are males in their 30s or 40s, who use such objects for autoerotic purposes [3,9]. It is important to know the history of similar episodes and any psychosexual behavior abnormalities in such individuals a proper history and examination is mandatory to look for signs and symptoms of perforation and infection, such as fever, severe abdominal pain and bleeding [10–12].
Management of unusual rectal foreign body – Case report and literature review
2022, International Journal of Surgery Case ReportsBroken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation
2021, International Journal of Surgery Case ReportsA Curious Case of Hemoperitoneum
2021, Journal of Emergency MedicineUnusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder
2020, Radiology Case ReportsCitation Excerpt :Odagiri et al. reported potential accidental foreign body ingestion (eg, fish bones) due to mental disorders, particularly in older females [3], whereas Poynter et al. wrote about deliberate ingestion due to psychiatric diagnoses such as borderline personality disorder [2]. These articles present clinical cases in which CT (for example) can be a helpful tool in the detection and visualization of ingested foreign bodies; additionally, CT can guide surgeons in determining the location of a foreign body [6,9]. In living individuals, imaging procedures such as CT represent a decisive diagnostic method leading to fast and appropriate, and likely life-saving, therapy for affected patients.