Difference between revisions of "Rectal foreign body"

(Diagnosis)
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==Background==
 
==Background==
*Most are in the rectal ampulla and therefore palpable on digital examination
+
*Make sure that object is not sharp before exam
**Make sure that object is not sharp before exam
+
*Injuries may consist of hematoma, lacerations (with potential perforation)
*Injuries may consist of hematoma, lacerations (w/ potential perforation)
 
  
 
==Clinical Presentation==
 
==Clinical Presentation==
 
*Rectal pain and/or fullness
 
*Rectal pain and/or fullness
 
*History of rectal foreign body placement
 
*History of rectal foreign body placement
 +
*Most are in the rectal ampulla and therefore palpable on digital examination
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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===ED removal===
 
===ED removal===
 
''Suitable for non-sharp objects that are in the distal rectum''
 
''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
+
#Sedation
**Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
+
#*IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
*Anal lubrication
+
#*Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
*In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
+
#Manual removal
*If obstetric forceps needed, pt should bear down as object is extracted.
+
#*Anal lubrication
*Large bulbar objects create a vacuum-like effect
+
#*In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
**Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
+
#*If obstetric forceps needed, patient 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 Indications===
 
===Surgical Consultation Indications===
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*ED attempts fail
 
*ED attempts fail
 
*Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
 
*Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
 +
 +
==Disposition==
 +
*Consider observation for at least 12hr if concern for rectal perforation
  
 
==See Also==
 
==See Also==
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*[[Foreign bodies]]
 
*[[Foreign bodies]]
  
==Source==
+
==References==
*Tintinalli
 
*Roberts
 
  
 
[[Category:GI]]
 
[[Category:GI]]

Revision as of 10:32, 21 January 2016

Background

  • Make sure that object is not sharp before exam
  • Injuries may consist of hematoma, lacerations (with potential perforation)

Clinical Presentation

  • Rectal pain and/or fullness
  • History of rectal foreign body placement
  • Most are in the rectal ampulla and therefore palpable on digital examination

Differential Diagnosis

Anorectal Disorders

Diagnosis

Foreign body noted in rectum on lateral abdominal xray
  • 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

  1. Sedation
    • 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.
  2. Manual removal
    • Anal lubrication
    • In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
    • If obstetric forceps needed, patient 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)

Surgical Consultation Indications

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

Disposition

  • Consider observation for at least 12hr if concern for rectal perforation

See Also

References