What is the treatment for a foreign object, such as a beer bottle, in the rectum (rectal cavity)?

From the Guidelines

The treatment for a foreign object, such as a beer bottle, in the rectum requires immediate medical attention at an emergency department, where a bedside extraction attempt should be made as the first-line therapy, if the object is low-lying and there are no signs of perforation, as suggested by the WSES-AAST guidelines 1.

Key Considerations

• The location of the foreign body is crucial in determining the treatment approach, with low-lying objects potentially being removed through bedside extraction, and high-lying objects requiring endoscopic extraction 1.
• The presence of signs of perforation or hemodynamic instability contraindicates transanal extraction, and urgent surgical exploration is recommended instead 1.
• The use of anesthesia, such as pudendal nerve block, spinal anesthesia, or intravenous conscious sedation, can help relax the patient, reduce anal sphincter spasm, and improve visualization, increasing the chances of successful transanal retrieval 1.
• Post-extraction proctoscopy or flexible sigmoidoscopy is suggested to evaluate the bowel wall status and identify any potential complications, such as perforation or retained fragments 1.

Treatment Approach

• For low-lying foreign bodies without signs of perforation, bedside extraction under sedation or anesthesia is the recommended first-line approach 1.
• For high-lying foreign bodies, endoscopic extraction using techniques such as rigid or flexible sigmoidoscopy, polypectomy snare, or endoscopic grasper, is the suggested first-line therapy 1.
• In cases where transanal extraction is unsuccessful, or the foreign body is high-lying, surgical intervention may be necessary to ensure safe removal 1.

Important Considerations

• Patients with suspected drug concealment require modified treatment approaches to avoid disrupting the drug package and causing potential life-threatening complications 1.
• The use of post-extraction endoscopy is debated, but its routine use is suggested to check for bowel wall damage and identify potential complications 1.

From the Research

Treatment for a Foreign Object in the Rectum

The treatment for a foreign object, such as a beer bottle, in the rectum (rectal cavity) involves various techniques, including:

• Manual extraction without anesthesia for low-lying objects 2
• Transanal removal under general anesthesia for high-lying objects 3, 2
• Use of laparoscopic specimen extraction bags to remove objects that are hard to grasp with clamps 4
• Removal with the assistance of a colonoscope under anesthesia 3
• Milking towards the transanal route during laparotomy 3
• Hartmann procedure without restoration of bowel continuity in some cases 3

Considerations for Treatment

When treating a foreign object in the rectum, it is essential to consider the following:

• The size and shape of the object, as well as the material it is made of 5
• The patient's medical history and any potential comorbidities 6
• The risk of perforation and other complications, such as bleeding, sepsis, and peritonitis 6, 2
• The need for caution when performing diagnostics to rule out perforation and establish a treatment algorithm 5

Complications and Outcomes

The complications and outcomes of treating a foreign object in the rectum can vary, but may include:

• Perforation of the rectosigmoid 2
• Lacerations of the mucosa 2
• Bleeding and sepsis 6
• Peritonitis and wound infection 6
• Mortality rates of up to 38% in cases with unfavorable factors 6
• A total complication rate of 30.4% 5
• A Clavien-Dindo grade III-IV complication rate of 9.5% 3