Colorectal emergencies associated with penetrating or retained foreign bodies

Abstract

BackgroundForeign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem.MethodsData were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed.ResultsAll the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out.ConclusionA careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.

A play that went wrong: Unique presentation of bowel perforation from an unusually large per-rectal foreign body

“…The most common signs and symptoms include abdominal pain, per-rectal bleeding and rarely obstruction with or without sepsis that are associated with chronically retained objects or with other complications such as perforation and peritonitis 2–4 6. Most of these FBs are ingested and only 15% of patients, like in our case, present with a history of FB insertion through the rectum 6. A digital rectal examination (DRE) has been reported to be of paramount importance in literature 3 8.…”

“…In the absence of peritoneal contamination and cases where the colonic laceration is less than three-quarters to half of the circumference of the colon, like in this case, a primary repair can be attempted with a period of postoperative parenteral nutrition 4 11. The decision to make a colostomy versus primary repair alone will depend on level of intra-abdominal contamination, extent of rectal injury and chronicity of the case 6. The use of colonoscopy and importance of psychiatric evaluation has been emphasised as a part of postextraction management for uncomplicated cases to rule out any missed bowel injuries and psychiatric problems, respectively 3.…”

Unusual Two Foreign Bodies in Rectum: Case Report

“…The mortality and morbidity rates of patients presenting with perforation above the peritoneal reflection have been reported to range from 2.5 to 20.0% and 20.0 to 40.0%, respectively [8,9].…”

Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects

“…21,22 Chest x-ray should be performed to identify the perforation, as there might be free air under the diaphgram. 23 MDCT of the abdomen and pelvis (Figs. 8 and 9) is rarely required in the evaluation of retained rectal foreign bodies.…”