Editing Rectal foreign body


== Epidemiology ==

* Most patients are men aged     30-50

== Classification ==

* Voluntary vs involuntary

== Investigation ==

* Start with upright AXR to     look for pneumoperitoneum and flat film to identify the object
* CT for those in whom the     x-ray is insufficient

== Approach to management ==

* Exclude perforation     (clinically and radiographically)
* Attempt removal in ED
* Proceed to manual removal     under GA with endoscopy
* Laparotomy and milking it out
* Colotomy

== Trans-anal removal ==

* IV sedation and pudendal +     intersphincteric block are both very helpful, or GA
* Lithotomy
* Abdominal pressure
* Kocher clamp or tenaculum
* Flex sig afterwards
* Techniques for blunt/slippery     objects
** Foley catheter inflated      proximal to it
** Injection of air above it
** Magnets for metal objects
** Inflation of the balloon      from a sengstaken-blakemore tube inside the object (such as a jar)
** Obstetric vacuum device

== Endoscopy ==

* Snares can be helpful

== Surgery ==

* Required in patients with     unsuccessful removal or evidence of perforation/peritonitis
* Try to milk it out through     the anus distally
* If unsuccessful, need to make     a colotomy. No need to divert.

== Surgery for perforation ==

* Primary repair vs diversion     vs end colostomy depending on patient factors and local factors

[[Category:Colorectal]]
[[Category:Intern education]]