A Management Algorithm for Retained Rectal Foreign Bodies

Abstract

Few authors have proposed therapeutic protocols to manage retained rectal foreign bodies (RFBs). All patients with retained RFBs in hospitals across Trinidad and Tobago over 5 years were identified. Hospital records were retrieved and manually reviewed to extract the following data: demographics, history, foreign body retrieved, clinical signs at presentation, management strategy, duration of hospitalization, and morbidity and mortality. There were 10 patients with RFBs over the study period. The annual incidence of this phenomenon was 0.15 per 100,000 population. All patients were men at a mean age of 50.6 years (range: 27-83; SD = 15.3) who presented after a voluntary delay of 1.4 days (range: 0.5-2.5; SD = 0.7). Only one patient gave an accurate history on presentation, but all eventually admitted to self-insertion for sexual gratification. At presentation, one patient had a spontaneous rectal perforation (10%). The remaining nine patients had attempts at bedside transanal extraction, which was unsuccessful in 89% (8/9) of cases. The RFB was pushed beyond the grasp of forceps, making removal under anesthesia unsuccessful in 62.5% (5/8) cases. These patients required more invasive extraction methods including transanal minimally invasive surgery (1), laparoscopic-assisted advancement with transanal retrieval (1), and open surgery with transmural extraction and anastomoses (3). A management algorithm is proposed for the management of RFBs. Important points in this algorithm are the importance of clinician–patient rapport, early surgical referral, avoidance of bedside extraction in the emergency room, early examination under anesthesia, and the inclusion of emerging therapies such as transanal minimally invasive surgery.

Vacuum-assisted foetal delivery device to remove a rectal foreign body – A novel application of the Ventouse method

“…Patients with RFBs usually have delayed presentations to the emergency department seeking help with removal after unsuccessful self-attempts, or may present with vague lower abdominal pain or rectal bleeding -rarely do they present with an acute abdomen [2,3]. The most common reason for object insertion is sexual gratifi cation, however due to the sensitive nature of the presentation patients may not be forthcoming with details, with many citing accidental insertion [2,4]. Other circumstances include assault and "body packing" for concealing objects [4].…”

Unusual presentation of a rectal foreign body: a diagnostic dilemma

“…The incidence of rectal foreign body was reported 0.13 in 100000 population, similar in population across the globe. 5 A systematic review shows that the incidence of retained colorectal foreign body is disproportionally higher in men, with a ratio of 37:1. 6 90% of patients give inaccurate history at presentation, some reported to present with peritonitis and was not forthcoming even when facing life threatening situation.…”

“…6 90% of patients give inaccurate history at presentation, some reported to present with peritonitis and was not forthcoming even when facing life threatening situation. 1,4,5 The usual presentation are anal pain, per rectal bleeding, constipation. 1,5 In this case, a rare presentation of acute urinary retention and perianal abscess.…”

Foreign Body Insertions: A Review

“…Additionally, these researchers reported that in 63% of the failed extractions, the objects were inadvertently pushed higher into the rectosigmoid region, and therefore recommended early mobilization of the OR team so that exploration under anesthesia can be performed under optimal conditions. 8 Once the foreign body is successfully removed, follow-up imaging or postextraction endoscopy is warranted. Close observation in the hospital is recommended to facilitate serial abdominal examination.…”