Rectal Foreign Body Research Articles

Unusual rectal foreign bodies: Case series and discussion

A series comprised of 04 patients is presented. The symptomatology, physical and x-ray findings are described. Methods of management are discussed, with emphasis on the operative management of perforations and the conservative approach to retained foreign bodies. It is felt that these protocols will be useful to physicians who see this practice less frequently. X-rays of two more unusual cases are depicted. A thorough review of the literature is also presented.

S2105 Rectal Foreign Body Necessitating Surgical Intervention

Introduction: Rectal foreign bodies (RFB) present a unique management dilemma due to the variety of objects transanally impacted and their subsequent range of local trauma. A reluctance to seek medical assistance and present a candid recount of the incident can make diagnosis challenging and pose delays, further worsening the degree of injury before timely intervention can be provided. Consequently, our case aims to illustrate a systematic approach to the diagnosis and management of irretrievable rectal foreign bodies. Case Description/Methods: The case illustrates a 45-year-old gentleman who presented to the ER with severe rectal pain. He reported that earlier in the day, he had felt adventurous and had self-inserted a rubber sex toy into his rectum. He had been unsuccessful in removing the toy despite multiple efforts and explained that, as time passed, he experienced worsening rectal pain with mild bleeding at the insertion site. Upon confirmation of a large palpable foreign body on the rectal exam, a computed tomography of the abdomen/pelvis showed a large triangular radiopaque foreign body within the rectum measuring 8.8 × 9.4 × 17.0 cm along with severe rectal wall thickening. The patient was immediately taken to the operating room where multiple attempts to transanally remove the impacted object were unsuccessful. This ultimately necessitated an exploratory laparotomy and colotomy with subsequent partial colectomy. An end colostomy was matured after field contamination from the spillage of colonic contents during the extraction of the foreign object (Figure). Discussion: Rectal foreign bodies continue to be a clinical challenge with their increasing incidence. Although there is a predominance of RFBs in males, it is important to keep an impartial perspective. Notably, it is crucial to understand that RFBs are not limited to sexual satisfaction - but instead could be used for non-sexual purposes (ie, packing of illicit drugs). Consequently, all RFBs need to be regarded as potentially hazardous. The presented case highlights the importance of a systematic approach which includes ruling out peritoneal signs via physical exam and imaging for potential evidence of perforation. Thereafter, it is important to attempt a manual and transanal removal of the RFB. If all approaches are unsuccessful, surgery via laparoscopy will be necessary. During surgery, the object can be "milked" toward the rectum to be removed transanally. If unsuccessful, however, a colotomy is imperative as illustrated in the presented case.Figure 1.: (a) CT Abdomen/Pelvis transverse view showing displaced anterior urinary bladder secondary to mass effect from the large rectal foreign body (b) Sagittal view of radiopaque foreign body within the rectum measuring 8.8 × 9.4 × 17.0 cm in greatest TV/AP/CC dimensions (c) Post-surgical removal after unsuccessful transanal extraction.

A retrospective analysis of transanal surgical management of 291 cases with rectal foreign bodies.

Rectal foreign bodies (RFB) are quite uncommon except in very busy hospitals. Because of their rarity, it is seldom that the treating physicians have a standard approach to the diagnosis, technique of extraction, and post-extraction evaluation. This can be further complicated by the rather extreme variability of size, shape, and texture of the foreign bodies, as well as the potential extent of trauma to the rectum or distal colon. The objectives of this study were to delineate the demographics, classification of cause, and injury patterns of RFB and to present the results of the transanal surgical management of a large series of RFB. We retrospectively collected extensive data from the hospital medical records of the 291 patients who presented with RFB to the emergency department of Shenyang Proctological Hospital (Shenyang, China) from 2012 July to 2020 December. Specifically, demographics, origins and circumstance of the RFB, complications, injuries, anesthesia method, and the results of the transanal surgical management were recorded and analyzed. Of the 291 RFB cases, 225 (77.3%) were male and 66 (22.7%) were female, with a mean age of 53.8 ± 15.5years (range, 1 ~ 88years). The circumstances of the RFB were categorized as swallowed, 199 cases (68.4%); self-inserted, 87 (29.9%); and iatrogenic, 5 (1.7%). The proportion of males in the self-inserted RFB group was significantly greater than the swallowed RFB group (t = 31.114, p = 0.000). In the swallowed RFB group, the most common anorectal injuries and pathological changes were the following: penetration into the mucosa (75 cases, 37.7%), perianal or submucosal abscess (27 cases, 13.6%), and penetration into the anal canal (18 cases, 9.0%). In the self-inserted RFB group, 64 (73.6%) of the 87 cases had an intact rectum, whereas 8 (9.2%) had rectal mucosal ulcers and bleeding, and 7 (8%) had rectal lacerations. In the iatrogenic RFB group, 3 cases (60%) had rectal mucosal ulcers and bleeding, and 2 cases (40%) had inflammation of the rectal mucosa. Regarding extraction procedures, in the swallowed group, 187(187/199; 94%) patients underwent a transanal surgical procedure, and all were successful. In the self-inserted group, 82 patients underwent the transanal surgical procedure, and 74 (74/82; 90.2%) were successful whereas it was unsuccessful in the remaining 8 patients (8/82, 9.8%). Three (3/4, 75%) patients with iatrogenic RFB were resolved by the transanal surgical procedure. Men were markedly more likely than women to have swallowed RFBs and self-inserted RFBs. No serious damage to the rectum and anus was found in cases of swallowed RFB. Moreover, most surgical operations to remove foreign bodies via the anus were successful in this category of RFB. In contrast, rectal injury was more severe in patients with self-inserted RFB, such as rectal laceration, rectal mucosal ulcer, and bleeding. Moreover, the transanal removal operation in patients with self-inserted RFB had a failure rate of nearly 10%. Thick, long, hard foreign bodies did present a great challenge to the operator. Therefore, if necessary, patients with foreign bodies may need to be promptly referred for transabdominal removal.

Foreign Body in Sigmoid Colon

ABSTRACT Colorectal foreign bodies are not an uncommon event in clinical practice. Rectal foreign bodies are inserted transanally either accidentally or intentionally for sexual purpose or smuggling of drugs or other substances. Here, we report a case of foreign body in sigmoid colon. A 26-year-old male was presented with history of lodging of deodorant bottle in his rectum. Erect abdomen radiograph showed a sharply delineated cylindrical bottle in lower abdomen and pelvis. Plan for removal of foreign body under spinal anesthesia was made. Mini-laparotomy was done and foreign body was retrieved out per rectally by gentle squeezing of sigmoid colon.

SP10.1.1 A retrospective study: Rectal foreign bodies, enter at your own risk…

Abstract Aims Entrapped rectal foreign bodies (FB) are being encountered by acute surgical teams with increasing frequency and can be a challenge to manage. This study aims to highlight typical patient demographics, risk factors for presentation and management options for these patients. Methods Between 2017 and 2021, 29 cases of rectal FB were diagnosed and managed at East Kent Hospital University Foundation trust. Retrospective data taken from theatre directory and electronic notes was used to audit patient demographics, co-morbidities, the type of foreign body and the extraction technique. Results The majority of patients were male (87%). The patient's age ranged from 15 to 78 years, with a median age of 48 years. In the majority of cases, the FB had become entrapped during sexual activity. Nineteen patients (65%) underwent examination under GA for removal, seven patients (24%) were manually evacuated and three required a laparotomy (10.3%). Nine patients (31%) had a history of known mental health problems. The most common FB removed was a roll-on deodorant (n=5). Conclusion Cases of rectal FB's needing surgical management typically involve male patients in their 40's. While a small proportion can have manual evacuation, the majority require examination under anesthetic and in some cases a laparotomy. While a larger study would be required for significance, it appears a history of mental health problems may predispose patients to presenting with this problem. Patients present with a wide range of foreign body type, typically items commonly found in the home, the most common being roll on deodorant.

Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness.

BackgroundEntrapped rectal foreign bodies can be a challenge to manage and are being encountered by acute surgical teams with increasing frequency. The aims of our study were to (a) ascertain the population demographics of patients presenting with this problem in our local area of East Kent, (b) see if an association could be drawn between this presentation and proposed risk factors such as a psychiatric illness or socioeconomic deprivation, and (c) to review how foreign bodies are being removed in the East Kent Hospital University Foundation NHS Trust, United Kingdom and to highlight best practice with regards to this in line with the latest guidelines.MethodologyBetween 2017 and 2021, 32 cases of entrapped rectal foreign bodies were diagnosed and managed at our NHS Trust. Retrospective data taken from the theatre directory and electronic patient records were used to audit patient demographics, co-morbidities, the type of foreign body, and the extraction technique.ResultsThe majority of patients (90%) were male (n = 29). The patients’ age ranged from 15 to 95 years, with a median age of 48 years. In total, 12 (37.5%) patients had a medical history of a psychiatric illness. The most common foreign bodies removed were sex toys or vibrators (n = 8) and roll-on deodorant bottles (n = 7). Kent Area B (n = 10) and Kent Area A (n = 9) were the areas with the highest number of cases. Twenty-two (68.8%) patients underwent examination under a general anaesthetic for removal, seven (21.8%) patients had the object manually removed without sedation, and three (9.4%) required a laparotomy with or without bowel resection.ConclusionsCases of an entrapped rectal foreign body in this local region typically involved male patients between 40 and 50 years old. A high proportion of this group had a history of a psychiatric illness supporting an association between this presentation and mental health. We have proposed some explanations for this association including the anal canal nervous system interplay with the “brain-gut axis.” Lower socioeconomic status and unemployment may also be risk factors for this surgical problem. A trans-anal approach for management is successful in the majority of cases; however, almost 10% of patients required emergency surgical management. We have highlighted best practice guidelines for the investigation and management of the entrapped rectal foreign body as part of our discussion.

STUCK UP!!!- CASE REPORT OF A RECTAL FOREIGN BODY

Rectal foreign bodies have a been a part of history for causing anorectal trauma. The first described report on the management of retained rectal foreign bodies dates back to the 16th century,and the first case reports of the modern era were published in 1919. The mean age at presentation is 44 years with a decidedly higher proportion of male patients.Mostly the foreign body found in rectum are inserted with an attempt to hide illegal objects or for sexual activities, and patients do not share complete and proper history with the treating doctor because of Embarrassment which complicates the management. We present a case of 30-year-old /M, who works in a plastic factory presented to casualty with c/o Constipation and Abdominal pain. On Detailed History the Patient explained the incident of inserting a self-made plastic tube in the Rectum which failed to come out on trying. On Xray Abdomen Erect s/o dilated bowel loops, with no gas under diaphragm. CECT showed large oblong foreign body in Rectum. Patient was taken to operating room and Manual removal of Foreign Body done under Spinal Anaesthesia. Foreign body was found to be a tubular, blunt, atraumatic plastic tube. Thus, we present a case of Rectal Foreign body which could be removed without operative intervention as the object was blunt and patient presented early to casualty.

Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature.

Retained rectal foreign bodies (RFBs) are uncommon clinical findings. Although the management of RFBs is rarely reported in the literature, clinicians regularly face this issue. To date, there is no standardized management of RFBs. The aim of the present study was to evaluate our own data and subsequently develop a treatment algorithm. All consecutive patients who presented between January 2006 and December 2019 with rectally inserted RFBs at the emergency department of the Klinikum Stuttgart, Germany, were retrospectively identified. Clinicopathologic features, management, complications, and outcomes were assessed. Based on this experience, a treatment algorithm was developed. A total of 69 presentations with rectally inserted RFBs were documented in 57 patients. In 23/69 cases (33.3%), the RFB was removed transanally by the emergency physician either digitally (n = 14) or with the help of a rigid rectoscope (n = 8) or a colonoscope (n = 1). In 46/69 cases (66.7%), the RFB was removed in the operation theater under general anesthesia with muscle relaxation. Among these, 11/46 patients (23.9%) underwent abdominal surgery, either for manual extraction of the RFB (n = 9) or to exclude a bowel perforation (n = 2). Surgical complications occurred in 3/11 patients. One patient with rectal perforation developed pelvic sepsis and underwent abdominoperineal extirpation in the further clinical course. The management of RFBs can be challenging and includes a wide range of options from removal without further intervention to abdominoperineal extirpation in cases of pelvic sepsis. Whenever possible, RFBs should obligatorily be managed in specialized colorectal centers following a clear treatment algorithm.

Management of unusual rectal foreign body - Case report and literature review.

IntroductionRetained rectal objects represent a rare complaint in the emergency room, affecting mainly males between 20 and 40 years, with most objects of a sexual nature, but the examiner must be aware of objects of an unusual nature.Presentation of caseA 54-year-old male patient arrives at the surgical emergency department, with a report of an accident with the insertion of an object via the rectum, a gym dumbbell. Initially opted for transrectal object removal, but with difficulties due to its position.DiscussionRetained rectal objects are a rare complaint in the emergency department, but with an increasingly important occurrence in recent years. Physical examination should include an assessment of the abdomen and digital rectal examination. Imaging tests are mandatory for diagnosis, with abdominal and pelvis radiography being the most requested. Although there is no consensus on the most appropriate removal technique, less invasive initial approaches are recommended, with transanal removal with a 60–75% success rate under local anesthesia. The follow-up after the procedure depends on several factors, and in general, the patient should be kept under observation and attention should be paid to significant changes in the evolution and alterations in the imaging tests.ConclusionThe clinical history in these cases can be confusing, due to the patient's fear of reporting the complaints. Radiography is the best initial test, and CT is reserved for cases of suspected complications. Whenever possible, perform the extraction rectally.

Rectal foreign body of suppository package: risk of self-insertion of suppositories among elderly.

Rectal foreign body of suppository package: risk of self-insertion of suppositories among elderly.

Systematic review of rectal foreign bodies in older men: humanistic care and a novel challenge for society.

BackgroundIn recent years, rectal foreign bodies have become a common proctological emergency in the male population, especially older Chinese men, often requiring surgical intervention due to associated complications. This review aimed to describe the epidemiology and clinical characteristics of rectal foreign bodies in older men and examine the possible challenges presented by the condition to clinicians and society.MethodsA comprehensive search was conducted in English-language databases and Chinese databases from January 2000 to December 2020. Studies concerning rectal foreign bodies were considered for this review if they reported the reason for a foreign body being in the rectum and related treatment measures. Contemporaneous rectal foreign bodies case data from General Surgery Department of Tangdu Hospital were also analyzed. According to differences in ethnicity, the older male patients were divided into a Chinese group and a non-Chinese group, and the parameters of the two groups were analyzed using statistical methods.ResultsA total of 159 studies were retrieved in an initial database search using “rectal foreign body” as the search term. These included 86 Chinese studies and 73 English-language studies. Collectively, these studies included 582 older male patients, 276 of whom were Chinese, and 307 who were non-Chinese. According to their source, the rectal foreign bodies were classified into 3 categories. The most common reason for a foreign body in the rectum was insertion for erotic purposes, with everyday articles accounting for most foreign body types. Sexual articles were mainly found to have been used in the pursuit of pleasure. There were no significant differences in foreign body sources, sizes, types, treatment selections, and outcomes between the two groups.DiscussionEmergency hospital visits by older men with rectal foreign bodies due to erotic and sexual needs and practices are increasing. Although the sources, sizes, and types of foreign bodies were different, and patients recovered well after active and appropriate clinical treatment, the sexual needs of older men are a social issue that requires attention. Acknowledging and dealing with sexual issues is a multidimensional task that requires a collaborative effort to ensure a more humanistic approach to older patients.

Unusual finding of deodorant bottle in the rectum

A foreign body in the rectum is not an uncommon encounter in current medical practice. In most cases, rectal foreign bodies are a result of sexual eroticism, sexual abuse, assault, or rarely, accidental involuntary insertion. It poses diagnostic difficulties and management challenges among medical professionals. The diagnostic approach usually involves careful history and physical and radiological examination. Here, we present the case of a 22-year-old man with a retained rectal foreign body for a duration of 3 hours. He presented with impacted foreign body per rectum, non-specific abdominal pain, abdominal mass, and non-passage of stool and flatus. Successful removal of the rectal foreign body was done manually under local anesthesia in the lithotomy position in the operation theatre.

A Case Report of Rectovaginal Fistula Associated with a Rectal Foreign Body Neglected for as Long as 5 Years

症例は28歳，女性．5年前からパートナーの性的嗜好で直腸および膣への異物挿入が繰り返されていた．同時期より帯下の増量を自覚し，受診1年前から帯下に便の混入があり，近医を受診した．大腸内視鏡検査で直腸にプラスチック製の蓋を認め，後膣円蓋から直腸前壁に直腸膣瘻を認めた．異物除去術を施行されたが，その後も膣からの帯下が便汁様になるため治療目的に当院へ紹介となった．直腸Rb前壁に直径3-4cm程度の瘻孔と膣狭窄を認め，注腸造影検査で直腸から膣への造影剤の漏出を認めた．瘻孔は大きく自然閉鎖が期待できないと判断し，腹腔鏡下低位前方切除術を予定し肛門管吻合および膣修復術を行った．術後，一時的に神経因性膀胱で自己導尿を要したが術後14病日で退院した．経肛門的直腸異物は数日から数週間以内に受診することが多い．長期間留置が要因となった直腸異物による直腸膣瘻をきたした報告は稀であるため，若干の文献的考察を加え報告する．

Novel technique for retrieval of rectal foreign body using suprapubic catheter.

A 40-year-old female presented with rectal discomfort due to retained lubricant bottle cap. She was hesitant to provide further details and has no medical comorbidities. There was no per rectal bleeding and no obstructive symptoms. There was no clinical evidence of external injury or perforation.

COVID-19 Pandemic Lockdown Resulting in an Unusual Rectal Foreign Body in a Young Male

Foreign body rectum may cause serious consequences, especially in psychologically vulnerable patients, In critical conditions like pandemic COPVID-19, when depression, fear boredom, loneliness such incidence may occur. An 18 years old young male presented in emergency with a foreign body rectum. He was a laborer on daily wages. During the COVID-19 pandemic, loneliness, anxiety, and unemployment have exposed him to bizarre behavior, resulting in inserting potato into his rectum. He denied any history of homosexuality. The diagnosis was made by examination. Per rectal examination found FB just above the anal verge. The foreign body was removed rectally under G/A. He was then referred to a psychiatrist for evaluation.

Rectal foreign body removal: increasing incidence and cost to the NHS.

Insertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS. Hospital Episode Statistics for 2010-2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared. A total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life. This study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.

Rectal foreign body, an impacted plastic ball: A case report and review of literature.

• Diagnosing rectal foreign body can be challenging due to a vague history or a late presentation. • Patients should be treated in a supportive nonjudgmental environment. • Surgeons should look for signs of perforation on presentation and after extraction. • Creativity is needed in case conventional extraction methods fail.

Management of Rectal Foreign Bodies: A Case Series Analysis

Management of Rectal Foreign Bodies: A Case Series Analysis

Rectal perforation caused by a self-inserted foreign body: a case report

Rectal foreign bodies have a storied history as a part of anorectal trauma. Objects encountered are most commonly household objects consisting of bottles and glasses. Other objects include tooth brushes, deodorant bottles, food articles, knives, sports equipment, cell phones, flash lights, wooden rods, broom sticks, sex toys including dildos and vibrators, light bulbs, nails, or other construction tools, christmas ornaments, aerosol canisters, cocaine packets, and many more. The reasons for insertion in decreasing order of frequency are autoeroticism, concealment, attention-seeking behavior, accidental, assault and to alleviate constipation. Here we presented a case of 32 years old presented to the ER with complaints of pain in lower abdomen and anal region for 12 hours. He complained of severe pain when he tried to defecate. He gave history of self-insertion of an empty drug vial into his rectum. Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The important factors in dealing with these patients are careful history and physical examination. Patients are often embarrassed about this condition and may conceal the truth. So, a high index of suspicion is required to accurately diagnose.

Impacted Large Unusual Rectal Foreign Bodies: a Case Series

Impacted Large Unusual Rectal Foreign Bodies: a Case Series