Rectal foreign bodies

Rectal foreign bodies are not uncommon in emergency departments around the world, and although they are often the source of endless amusement do potentially cause management difficulties.

Epidemiology

The incidence varies according to region, said to be uncommon in Asia and most common in Eastern Europe 1. Typically patients are male with wide range of age.

The vast majority of such objects are inserted via the anus and are the result of sexual misadventure. In older men, the objects may be introduced to aid in manual disimpaction for constipation or to massage the prostate. Occasionally a foreign body may be ingested (e.g. fish bone 2, chicken bone or wood splinters 3), and successfully navigates the entire gastrointestinal tract only to become impacted at the rectum. 

Clinical presentation

Patients usually know that there is something in their rectum although are often at a loss as to how the object got there.

The list of retrieved objects is legion, and due to the chronic nature of the habit are often surprisingly large. Objects reported in the literature include:

  • bottles
  • sex toys
  • vegetables
  • broomstick
  • axe handle
  • curtain rod
  • light bulb / fluorescent tube
  • frozen pig's tail
  • toothbrush
  • drug packets
  • cigar cover

Radiographic features

In almost all cases plain radiography suffices, and poses little diagnostic difficulty. Occasionally body packers (drug smuggling) or some softer silicone objects may be less radio-opaque. 

An erect chest x-ray is often useful if there is any suggestion of peritonism to assess for free gas.

Treatment and prognosis

Removal of such objects can be challenging depending on the shape, material and orientation within the rectum. If possible they should be removed via the anus, although in some cases a laparotomy may be required. Techniques described include:

  • manual extraction / obstetric forceps / snares etc.. 
  • abdominal pressure / manipulation may help
  • passing a Foley catheter distal to the object and inflating the balloon

Following successful transcanal retrieval colonoscopy/sigmoidoscopy is prudent to exclude colonic injury.

See also

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