Rectal Foreign Body Removal


INDICATIONS
  • All rectal foreign bodies (FB) should be removed when diagnosed.
CONTRAINDICATIONS
  • Severe abdominal pain or signs of perforation
  • Nonpalpable rectal FBs require surgical consultation.
  • Insufficient experience or equipment
TECHNIQUE
  • An X-ray may be useful to confirm the presence of a FB and to define its size and position.
  • Patient assumes knee-chest or lateral decubitus position.
  • IV sedation and/or perianal block may be required.
  • Perianal block: Local infiltration is administered circumferentially around the anus in the submucosal tissue.
  • Perform direct rectal examination (DRE) to gauge position/orientation of FB.
  • Application of suprapubic pressure while patient performs a valsalva maneuver may deliver FB.
  • If unsuccessful, an anoscope, rigid sigmoidoscope, vaginal speculum, or retractor can be inserted into the anus to visualize FB clearly. An instrument can then be used to secure and remove the FB along with the anoscope as a single unit.
  • If a vacuum is created between FB and mucosa, it must be released by distending the rectal wall around the FB with air. This can be done using a sigmoidoscope or a Foley catheter passed beyond the FB and balloon inflated.
COMPLICATIONS
  • Failure to remove FB
  • Mild mucosal edema and rectal bleeding are common.
  • Perforation or deep mucosal tear require hospitalization.
  • Cracking or shattering of glass FB may require surgical exploration and retrieval.
INTERPRETATION OF RESULTS
  • Removal of intact FB under direct visualization without abdominal pain, fever, or severe bleeding indicates successful removal.