What is the recommended approach for removing a foreign object from the rectum?

From the Guidelines

The recommended approach for removing a foreign object from the rectum is to attempt bedside extraction as the first-line therapy, especially for low-lying objects without signs of perforation, as suggested by the most recent guidelines 1. This approach should be done under appropriate sedation or anesthesia to minimize discomfort and risk of injury. The decision to attempt manual extraction, endoscopic removal, or surgical intervention depends on the object's size, shape, location, and the patient's clinical condition. Key considerations include:

• The location of the foreign body: low-lying objects may be amenable to bedside extraction, while high-lying objects may require endoscopic or surgical removal.
• The presence of signs of perforation or hemodynamic instability: these conditions necessitate immediate surgical intervention.
• The type and size of the object: sharp or large objects may require more invasive removal techniques. Before attempting removal, a thorough medical history and physical examination, including a digital rectal examination, should be performed to assess the situation and plan the best approach 1. It is also crucial to consider the possibility of drug concealment and take appropriate precautions to avoid disrupting the drug package, as this can lead to life-threatening complications 1. After removal, a proctoscopy or flexible sigmoidoscopy should be performed to evaluate the bowel wall status and check for any remaining fragments or injuries 1. Overall, the management of retained anorectal foreign bodies requires a careful and individualized approach, taking into account the specific circumstances of each case and prioritizing the patient's safety and well-being.

From the Research

Recommended Approach for Removing a Foreign Object from the Rectum

The removal of a foreign object from the rectum can be a challenging and delicate procedure. According to various studies, the approach to removal depends on the type of object, its location, and the patient's condition.

• The goals of therapy are to safely remove the foreign object and minimize injury to the bowel 2.
• A stepwise management approach is essential, including diagnosis, management, and post-extraction evaluation of the patient with a rectal foreign body 3.
• Manual extraction without anesthesia is only possible for very low-lying objects, while patients with high-lying foreign bodies generally require general anesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction 4.
• Various techniques have been described for the extraction of foreign bodies, including using endoscopic snares, Foley catheters, and various kinds of clamps to grasp the objects 5.
• In some cases, laparoscopic specimen extraction bags can be used to remove foreign bodies, especially spherical objects or objects that are hard to grasp with clamps 5.
• Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body 4, 6.
• In most cases, the removal of a foreign object can be performed peranally in the emergency room without further complications, representing the therapy of choice for rectal foreign bodies 6.

Key Considerations

• The type of object and its location are crucial factors in determining the approach to removal.
• The patient's condition, including hemodynamic stability and the presence of bowel obstruction or perforation, must be carefully evaluated.
• A well-organized and stepwise approach to management is essential to minimize complications and ensure successful removal of the foreign object 3, 4.
• The use of appropriate tools and techniques, such as endoscopic snares or laparoscopic specimen extraction bags, can facilitate safe and effective removal of the foreign object 5.