• Anorectal foreign bodies (FBs) may infrequently be the result of an orally ingested sharp object that becomes impacted; however, the majority are the result of objects that are inserted through the anal canal.
• Sharp ingested FBs usually present with symptoms of impaction such as bleeding, perforation, or abscess. The patient does not usually remember the ingestion and the object is identified during surgery.
• Most rectal FBs have been inserted deliberately by the patient or a sexual partner.
• There are reports of psychiatric patients inserting sharp FBs to injure the clinician performing a digital rectal examination.
• Assault victims may present with retained objects or fragments that may be blunt or sharp.
• Drug users may hide drugs or drug paraphernalia in their rectum, and prisoners have been found to conceal weapons in their rectum.
• Similar to ingested objects, inserted FBs may cause complications, but they are more frequently brought to the clinician’s attention because of an inability to remove the object.

• Risk has more to do with force of insertion than object itself.
• If you can palpate it on digital rectal exam and it won’t cut you then initial removal attempt is job of Emergency MD.
• High risk object, cannot palpate, multiple removal attempts, sick patient = call a surgeon.
• People are creative with what they put in – you need to be creative with how you remove; consider an assistant:
  • If you can pass a 3-way catheter or small ET tube beyond the object then inflation of balloon or installing air into the colon above the object may help break the seal and aid with extraction.
  • Procedural sedation often helps.
  • Simultaneous pressure on abdomen while pulling on the object has also been found useful.

High-risk object, cannot palpate, multiple removal attempts, sick patient = call a surgeon and probably admission.

Signs of perforation or local ability to remove foreign body.

Successful retrieval but concerns for perforation.

May miss small perforation – increasing pain or fever should trigger ED revisit.

1. Anderson and Anthony JD. Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies.  Emerg Med Clin N Am 29 (2011) 369–400.