Rectal foreign body: Difference between revisions

Revision as of 22:18, 19 April 2015

Background

Most are in the rectal ampulla and therefore palpable on digital examination
- Make sure that object is not sharp before exam
Injuries may consist of hematoma, lacerations (w/ potential perforation)

Clinical Presentation

Differential Diagnosis

Anorectal Disorders

Anal fissure
Anal fistula
Anal malignancy
Anal tags
Anorectal abscess
Coccydynia
Colorectal malignancy
Condyloma acuminata
Constipation
Crohn's disease
Cryptitis
GC/Chlamydia
Fecal impaction
Hemorrhoids
- Internal hemorrhoid
- External hemorrhoid
Levator ani syndrome
Pedunculated polyp
Pilonidal cyst
Proctalgia fugax
Proctitis
Pruritus ani
- Enterobius (pinworms)
Rectal foreign body
Rectal prolapse
Syphilitic fissure

Non-GI Look-a-Likes

Prostatitis

Diagnosis

Abdominal xray
- Demonstrate position, shapes, and number of foreign bodies
- Demonstrates possible presence of free air (perforation of rectum or colon)
  - Perf of rectum below peritoneal reflection shows extraperitoneal air along psoas ####Perf above peritoneal reflection reveals intraperitoneal free air under diaphragm
CT
- Useful when foreign body is radiolucent and for detection of free air

Management

ED removal

Suitable for non-sharp objects that are in the distal rectum

IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
- Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
Anal lubrication
In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
If obstetric forceps needed, pt should bear down as object is extracted.
Large bulbar objects create a vacuum-like effect
- Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
Observe for at least 12hr to ensure that object did not perforate the rectum

Surgical Consultation Indications

Removal could injure the sphincter
ED attempts fail
Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)

Source

Tintinalli
Roberts

Authors:

@@ Line 3: / Line 3: @@
 **Make sure that object is not sharp before exam
 *Injuries may consist of hematoma, lacerations (w/ potential perforation)
+==Clinical Presentation==
+==Differential Diagnosis==
+{{Anorectal DDX}}
 ==Diagnosis==
-*Abd xray
+*[[Abdominal xray]]
 **Demonstrate position, shapes, and number of foreign bodies
 **Demonstrates possible presence of free air (perforation of rectum or colon)
@@ Line 12: / Line 16: @@
 **Useful when foreign body is radiolucent and for detection of free air
-==Differential Diagnosis==
+==Management==
-{{Anorectal DDX}}
+===ED removal===
+''Suitable for non-sharp objects that are in the distal rectum''
+*IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
+**Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
+*Anal lubrication
+*In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
+*If obstetric forceps needed, pt should bear down as object is extracted.
+*Large bulbar objects create a vacuum-like effect
+**Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
+*Observe for at least 12hr to ensure that object did not perforate the rectum
-==Management==
+===Surgical Consultation Indications===
-#ED removal suitable for non-sharp objects that are in the distal rectum
+*Removal could injure the sphincter
-##Procedure:
+*ED attempts fail
-###IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
+*Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
-####Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
-###Anal lubrication
-###In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
-###If obstetric forceps needed, pt should bear down as object is extracted.
-###Observe for at least 12hr to ensure that object did not perforate the rectum
-#Large bulbar objects create a vacuum-like effect
-##Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
-#Surgical consultation indicated if:
-##Removal could injure the sphincter
-##ED attempts fail
-##Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
 ==See Also==
 *[[Anorectal Disorders]]
+*[[Foreign bodies]]
 ==Source==
 *Tintinalli
 *Roberts
 [[Category:GI]]