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Clinical Summary

Diagnosis of rectal foreign body is usually made by history and confirmed by digital examination. The foreign body is usually directly inserted into the rectum, but an ingested foreign body may also become trapped in the rectum. The most common and serious complication of a rectal foreign body is perforation of the rectum or sigmoid colon. Perforation superior to the peritoneal reflection is associated with intraperitoneal free air and peritoneal signs. Perforation inferior to the peritoneal reflection often causes retroperitoneal injuries and presents with more nonspecific complaints. Determine the size, shape, and number of objects to assess the risk of perforation. In children, rectal foreign bodies usually present as rectal bleeding. Imaging is indicated if there are significant concerns for perforation.

Management and Disposition

The patient must be carefully evaluated for evidence of perforation by detailed examination and radiographic studies as indicated. Obtain an immediate surgical consultation if perforation is present or suspected. Without perforation blunt objects may be manually removed in the emergency department with adequate local anesthesia and sedation. Surgical consultation for removal of sharp objects under proctoscopic or sigmoidoscopic visualization is recommended. If the risk of perforation appears high or adequate relaxation and anesthesia cannot be obtained, removal should proceed under general anesthesia.

Pearls

  1. A urinary catheter or small endotracheal tube may be passed proximal to some foreign bodies. This may release the vacuum effect of the rectum and the balloon may be inflated to aid in removal.

  2. A rectal foreign body in a child should raise the suspicion of abuse.

  3. Imaging after removal is needed to rule out perforation resulting from the procedure.

  4. Pelvis imaging is recommended prior to rectal exam in incarcerated patients to prevent injury from sharp objects often hidden in this location.

FIGURE 9.62

Rectal Foreign Body. This foreign body (a 7-oz beer bottle) required removal in the operating room. (Photo contributor: Kevin J. Knoop, MD, MS.)

FIGURE 9.63

Rectal Foreign Body. This victim of assault had a stick forced into his rectum. After removal, sigmoidoscopy revealed a retained small broken stick. (Photo contributor: R. Jason Thurman, MD.)

FIGURE 9.64

Rectal Foreign Body. Ventriculoperitoneal shunt tubing seen protruding from the anus after eroding through the transverse colon. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 9.65

Ventriculoperitoneal Shunt Tubing in Colon. Ventriculoperitoneal shunt tubing seen in the transverse colon and proceeding down the distal colon and exiting the anus. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 9.66

Rectal and Genitourinary Foreign Body. One handcuff is encircling the genitalia (...

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