Rectal foreign bodies
- Scott R Steele, MD, FACS, FASCRS
Scott R Steele, MD, FACS, FASCRS
- Professor of Surgery
- Case Western Reserve University
- Joel E Goldberg, MD, FACS
Joel E Goldberg, MD, FACS
- Assistant Professor of Surgery
- Harvard Medical School
Rectal foreign bodies can present a difficult diagnostic and management dilemma. They can be caused by a wide variety of objects, lead to variable degrees of local trauma to the surrounding tissues, and can be associated with perforation or delayed injury. Further complicating management is the variable degree to which patients are willing to disclose the underlying cause leading to their presentation and the frequently long delay before they seek medical attention. As a result, recognition and management require a systematic approach.
Published experience with rectal foreign bodies is based mainly on single-center case series (table 1). Studies of adults have suggested that most patients are men (65 to 100 percent) who are in their 30s or 40s (range 16 to 94 years) [1-3].
The incidence is not known precisely but rectal foreign bodies are seen regularly in most large hospitals. As an example, in a report from the University of California of patients seen between 1993 and 2002, approximately one patient per month received care for a rectal foreign body .
Placement has been categorized as voluntary versus involuntary (eg, rape, assault), and sexual versus nonsexual.
●Involuntary nonsexual foreign bodies often involve children or patients who are mentally ill. They have also resulted from medical instruments such as thermometers or enema tips, and, uncommonly, from per-oral ingestion of objects that become lodged in the colon (eg, bones, toothpicks, and small objects such as erasers or broken plastic utensils).
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- Rispoli G, Esposito C, Monachese TD, Armellino M. Removal of a foreign body from the distal colon using a combined laparoscopic and endoanal approach: report of a case. Dis Colon Rectum 2000; 43:1632.
- Demetriades D, Murray JA, Chan L, et al. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma 2001; 50:765.
- Herr MW, Gagliano RA. Historical perspective and current management of colonic and intraperitoneal rectal trauma. Curr Surg 2005; 62:187.
- Fry RD, Shemesh EI, Kodner IJ, et al. Perforation of the rectum and sigmoid colon during barium-enema examination. Management and prevention. Dis Colon Rectum 1989; 32:759.
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- TYPES OF FOREIGN BODIES
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- History and physical examination
- Laboratory findings
- Radiological evaluation
- Transanal approach
- - Blunt objects
- - Sharp objects
- - Body packers
- - Foreign body-induced perforation
- POSTREMOVAL MANAGEMENT
- SUMMARY AND RECOMMENDATIONS