LEAVE A COMMENT
Rectal Foreign Body
Cardinal Presentations / Presenting Problems, Gastrointestinal
- 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.
Criteria For Hospital Admission
High-risk object, cannot palpate, multiple removal attempts, sick patient = call a surgeon and probably admission.
Criteria For Transfer To Another Facility
Signs of perforation or local ability to remove foreign body.
Criteria For Close Observation And/or Consult
Successful retrieval but concerns for perforation.
Criteria For Safe Discharge Home
May miss small perforation – increasing pain or fever should trigger ED revisit.
Quality Of Evidence?
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Anderson and Anthony JD. Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies. Emerg Med Clin N Am 29 (2011) 369–400.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by the BC Emergency Medicine Network and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Feb 19, 2019
Visit our website at https://www.bcemergencynetwork.ca