Rectal foreign body

Background

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

Diagnosis

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

Management

1. ED removal suitable for non-sharp objects that are in the distal rectum
   1. Procedure:
      1. IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
         1. Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
      2. Anal lubrication
      3. In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
      4. If obstetric forceps needed, pt should bear down as object is extracted.
      5. Observe for at least 12hr to ensure that object did not perforate the rectum
2. Large bulbar objects create a vacuum-like effect
   1. Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
3. Surgical consultation indicated if:
   1. Removal could injure the sphincter
   2. ED attempts fail
   3. Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)

Source

Tintinalli Roberts