Rectal foreign body: Difference between revisions
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#Injuries may consist of hematoma, lacerations (w/ potential perforation) | #Injuries may consist of hematoma, lacerations (w/ potential perforation) | ||
==Diagnosis== | ==Diagnosis== | ||
*Abd 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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Anorectal DDX}} | {{Anorectal DDX}} | ||
Revision as of 13:37, 3 February 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)
Diagnosis
- Abd 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
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Hemorrhoids
- Pedunculated polyp
- Pilonidal cyst
- Proctitis
- Pruritus ani
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Management
- ED removal suitable for non-sharp objects that are in the distal rectum
- Procedure:
- 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.
- Observe for at least 12hr to ensure that object did not perforate the rectum
- IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
- Procedure:
- 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
Source
- Tintinalli
- Roberts