Difference between revisions of "Rectal foreign body"

(Background)
Line 3: Line 3:
 
**Make sure that object is not sharp before exam
 
**Make sure that object is not sharp before exam
 
*Injuries may consist of hematoma, lacerations (w/ potential perforation)
 
*Injuries may consist of hematoma, lacerations (w/ potential perforation)
 +
 +
==Clinical Presentation==
 +
==Differential Diagnosis==
 +
{{Anorectal DDX}}
  
 
==Diagnosis==
 
==Diagnosis==
*Abd xray
+
*[[Abdominal xray]]
 
**Demonstrate position, shapes, and number of foreign bodies
 
**Demonstrate position, shapes, and number of foreign bodies
 
**Demonstrates possible presence of free air (perforation of rectum or colon)
 
**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
 
**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==
 
==See Also==
 
*[[Anorectal Disorders]]
 
*[[Anorectal Disorders]]
 +
*[[Foreign bodies]]
  
 
==Source==
 
==Source==
 
*Tintinalli
 
*Tintinalli
 
*Roberts
 
*Roberts
 +
 
[[Category:GI]]
 
[[Category:GI]]

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

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)

See Also

Source

  • Tintinalli
  • Roberts