Rectal Foreign Bodies

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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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