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