The Management of Retained Rectal Foreign Body

Abstract

Purpose: Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.Methods: We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.Results: All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.Conclusion: Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

Caring for a patient with a rectal foreign body

“…Although obtaining an accurate history may be difficult, it is important to determine if the RFB occurred due to assault. 2,5 Signs and symptoms of RFBs can include abdominal pain; rectal bleeding; nausea; constipation; lack of flatulence; diarrhea; or signs of perforation of the gastrointestinal (GI) tract, such as pneumoperitoneum, peritonitis, or signs of sepsis. 3,6 Tachycardia, hypotension, and fever may indicate peritonitis and sepsis secondary to GI perforation.…”

“…When caring for a patient with an RFB, consider the sensitive nature of the diagnosis and approach the patient with a nonjudgmental attitude. 2 It can be difficult to obtain an accurate history due to embarrassment or fear of stigmatization. 4 Many patients are reluctant to reveal details regarding the RFB and implausible situations may be given, such as accidentally sitting on the object.…”

“…A thorough patient history can provide details of the RFB—what it is, how it was placed, duration of placement, as well as any actions taken to remove it. Although obtaining an accurate history may be difficult, it is important to determine if the RFB occurred due to assault 2,5…”

“…1 Examples of RFBs include phallic-shaped items, lids, containers, jars, and toothbrushes. 2 Due to the embarrassment of the situation, patients often delay seeking medical attention, which can defer treatment by weeks, months, or even years. 3 Nurses must exhibit sensitivity and professionalism and know the clinical manifestations, management, and post-removal care related to RFBs to provide optimal and safe patient care.…”

“…Sophia Parsh, BSN, RN, Hyun Ah “Esther” Oh, BSN, RN, and Bridget Parsh, EdD, CNS, RN, CPN respond— While the causes for RFBs vary, common circumstances include sexual gratification, anal eroticism, accidental insertion, assault, “body packing” for concealing objects (such as drugs or weapons), and treatments for hemorrhoids and constipation 1. Examples of RFBs include phallic-shaped items, lids, containers, jars, and toothbrushes 2…”