Rectal foreign body

Revision as of 03:05, 25 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")

Background

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

Clinical Features

  • 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

Evaluation

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