Background
Anorectal foreign bodies are usually inserted transanally for sexual or medicinal purposes. [1] Rectal foreign bodies may also be observed with body packing or stuffing or after previous oral ingestion of the object. Anorectal foreign bodies are more common in men than in women. [2] The incidence of the problem appears to be increasing. [3, 4, 5, 6]
Rectal foreign bodies may include such objects as bottles, vibrators, fruit, vegetables, and balls. Cylindrical objects are common. In addition, thermometers may accidentally break while a rectal temperature is being obtained.
The clinician should be aware that patients have usually made multiple attempts to remove the object before presentation in the emergency department (ED). Patients may create unusual stories to explain how the object became lodged in the rectum. Assault must be considered as a possible etiology for an anorectal foreign body. [7]
Indications
Indications for bedside rectal foreign body removal in the ED include the following:
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An object that is palpable on digital rectal examination (DRE)
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An object that is less than 10 cm proximal to the anal verge
Prompt removal is advisable. [8, 9, 10] Delayed removal of rectal foreign bodies can lead to severe complications, including the following:
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Perforation [11]
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Infection or sepsis
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Mucosal ulcerations, lacerations, or edema
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Obstruction
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Bleeding
Transanal removal is usually successful; however, some patients will require emergency surgical management. [12]
Contraindications
Absolute contraindications for bedside rectal foreign body removal in the ED include the following:
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Peritonitis
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Perforation
Relative contraindications for bedside rectal foreign body removal in the ED include the following:
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Severe abdominal pain
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An object that is not palpable on DRE
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An object that is more than 10 cm proximal to the anal verge
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Broken glass present in the anus or rectum
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A fragile object (eg, a light bulb)
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An extended time since insertion
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An inexperienced clinician
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An uncooperative patient
Technical Considerations
Anatomy
The rectum lies in the sacrococcygeal hollow and changes to the anal canal at the puborectal sling formed by the innermost fibers of the levator ani. It has a dilated middle part called the ampulla. (See Large Intestine Anatomy and Anal Canal Anatomy.)
The rectum is related anteriorly to the urinary bladder, prostate, seminal vesicles, and urethra in males and to the uterus, cervix, and vagina in females. Anterior to the rectum is the rectovesical pouch in males and the rectouterine pouch in females. The anal canal is related to the perineal body in front and the anococcygeal body behind; both of these are fibromuscular structures.
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Ring forceps.
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Tenaculum forceps.
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Vaginal speculum (closed).
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Vaginal speculum (open).
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Rectal speculum (closed).
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Rectal speculum (open).
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Rectal speculum (closed).
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Rectal speculum (open).
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Hill-Ferguson retractor.
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Rectal foreign body that is difficult to observe on radiography.
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Rectal foreign body readily visible on radiography.
