Rectal foreign body

Revision as of 10:26, 21 January 2016 by Rossdonaldson1 (talk | contribs) (Diagnosis)

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

  • Rectal pain and/or fullness
  • History of rectal foreign body placement

Differential Diagnosis

Anorectal Disorders

Diagnosis

Foreign body noted in rectum on lateral abdominal x-ray
  • 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