Rectal foreign body

Incidence

Typically (self-inflicted) inserted via the anal canal

Incidence

M > F (80% male) Peak incidence: 40yo (range 16-94yo)

Classification

• AAST injury scale
• Rectal organ injury scale
  • Grade I:
    • Haematoma
    • Contusion / haematoma, without devascularisation ± partial thickness laceration
  • Grade II:
    • Laceration ≤ 50% circumference
  • Grade III:
    • Laceration > 50% circumference
  • Grade IV:
    • Full-thickness laceration with extension into perineum
  • Grade V:
    • Devascularised segment

Aetiology

• Objects:
  • Usually ‘phallic-shaped objects’:
    • Vibrators, deodorant bottle, food, batteries
    • Other items: Drugs, money
  • Mode of placement:
    • Voluntary
      • Sexual practices
      • Non-sexual practice, e.g.
        • Thermometers, enema tips
        • ‘Body packing’ of illicit drug paraphernalia
        • Rarely: Impaction of ingested objects
    • Involuntary:
      • Rape, assault

Clinical

• Hx
  • Pt often embarrassed, may present late
  • Useful to know shape / components of FB
• Examination:
  • Abdo exam:
  • Mass, peritonism
  • PR
    • Be careful to protect yourself against sharp objects

Pathology

• Objects get ‘stuck’ due to
  • Spasm of sphincter
  • Angle of puborectalis sling
  • Curve of the sacrum
• Potential problems:
  • Pain & obstruction
  • Trauma to tissues → Oedema, bleeding, ulcer
  • Perforation
  • Sphincter injury
  • Rupture of ‘bag’ / condom containing illicit drugs
    • Overdose & death
  • Corrosive injury
    • e.g. Batteries – esp. from alkaline batteries that are impacted
  • Delayed injury
  • Anal sphincter laxity facilitates removal

Investigations

• X-ray:
• Gauge shape & position
• Rule out free air

Management

• Plan for removal in theatre
• Use Rectogesic / GTN
• Bimanual technique
• ± Use of Foley catheter, sponge forceps, Kocher
• Sigmoidoscopy after removal
  • Check for mucosal damage
• Laparotomy
  • “Milking’ the object out may be possible
  • Colotomy ± primary closure (and/or stoma) may be required

Prognosis/Natural Hx

• Pt frequently self-discharges
• ‘Uncomplicated’ removal is most common
• If perforation occurred → ↑ M+M

Follow-up

• Observe 24hrs for any sign of perforation / bleeding