Rectal Foreign Body

A rectal foreign body is an object retained within the rectum or distal sigmoid after transanal insertion, ingestion or less commonly migration from another site.

Management aims to remove the object without causing perforation or sphincter injury.

Object size, shape, fragility, position and evidence of bowel injury determine the extraction strategy.

Patients commonly present with rectal pain, inability to remove the object, bleeding or abdominal discomfort.

History should establish:

• Object type
• Sharpness
• Breakability
• Time since insertion
• Possibility of drug packets
• Previous extraction attempts

Severe abdominal pain, fever, tachycardia, peritonism or haemodynamic instability suggests perforation.

Obtain plain pelvic or abdominal imaging when the object is radiopaque or when its size and orientation are uncertain.

CT abdomen and pelvis: use when perforation or significant bowel injury is suspected.

Avoid blind digital manipulation when the object may be sharp or fragile.

A stable patient with a low lying blunt object and no evidence of perforation should undergo transanal extraction first. Adequate analgesia, sedation and relaxation are more important than force.

Place the patient in lithotomy or another position that permits abdominal manipulation and direct anal access.

Use controlled traction and avoid instruments that can shatter glass or push the object proximally.

If bedside extraction fails, proceed to theatre with deeper anaesthesia and sphincter relaxation.

A high lying object may be retrieved using flexible endoscopy.

Do not attempt endoscopic or forceful extraction of suspected drug packets because rupture can cause fatal overdose.

Perforation, peritonitis, ischaemic bowel or failure of transanal and endoscopic extraction requires abdominal surgery.

During laparoscopy or laparotomy, attempt to milk a suitable object distally for transanal extraction where safe before performing colotomy.

After removal, perform proctoscopy or flexible sigmoidoscopy to inspect for mucosal injury or perforation.