eMedicine Specialties > Emergency Medicine > Gastrointestinal

Foreign Bodies, Rectum: Differential Diagnoses & Workup

Author: David W Munter, MD, MBA, Assistant Clinical Professor of Emergency Medicine, Eastern Virginia Medical School; Medical Director, Emergency Medical Department, Sentara Obici Hospital; Partner, Emergency Physicians of Tidewater, LPC; President of the DESA Consulting Group
Contributor Information and Disclosures

Updated: Sep 28, 2009

Differential Diagnoses

Other Problems to Be Considered

Rectal wall perforation
Rectal wall laceration
Fecal impaction

Workup

Laboratory Studies

  • A hematocrit may be useful if bleeding is present. Obtain a white blood cell count with differential when infection is suspected. Obtain routine preoperative laboratory studies for patients who are operative candidates (eg, patients with signs of peritonitis, sepsis, or perforation, or with rectal foreign bodies that cannot be removed in the ED).

Imaging Studies

  • A flat plate radiograph of the abdomen or pelvis is indicated. The foreign object can be identified and localized in most cases.
  • A lateral pelvic film sometimes gives additional information regarding orientation of the foreign body, particularly whether its position is high- or low-lying.
  • An upright chest radiograph is indicated if perforation is suspected.


Typical appearance of a vibrator in the rectum.

Typical appearance of a vibrator in the rectum.

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Typical appearance of a vibrator in the rectum.

Typical appearance of a vibrator in the rectum.



Vibrator in the rectum. The patient attempted sel...

Vibrator in the rectum. The patient attempted self-removal with a pair of salad tongs, which also became lodged, resulting in two rectal foreign bodies. Multiple attempts at self-removal are typical in patients with rectal foreign bodies.

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Vibrator in the rectum. The patient attempted sel...

Vibrator in the rectum. The patient attempted self-removal with a pair of salad tongs, which also became lodged, resulting in two rectal foreign bodies. Multiple attempts at self-removal are typical in patients with rectal foreign bodies.

Procedures

Many rectal foreign bodies can be removed in the emergency department. Adequate analgesia and direct visualization are critical to success.

  • Provide analgesia such as morphine, hydromorphone, or fentanyl. Mild sedation, such as midazolam, may be indicated.
  • Position the patient in a knee-chest position or, as an alternative, the patient can be placed on a gynecology bed with stirrups.
  • Typically, an anoscope is used for visualization. Use direct lighting. Insert the lubricated anoscope. Grasp the visualized foreign body with forceps and slowly withdraw. If the foreign body cannot be visualized, do not make blind attempts with the forceps, but rather apply gentle pressure on the lower abdomen in an attempt to move the foreign body into the field of vision.
  • If the foreign body cannot be visualized even with abdominal pressure, consult a surgeon or a gastroenterologist.
  • If the foreign body can be visualized and grasped, but there are opposing suction forces hindering removal, insert a lubricated Foley catheter past the foreign body. This creates an air channel and facilitates removal.
  • Limit extraction attempts to 20-30 minutes. If unable to remove the foreign body, consult a surgeon or a gastroenterologist.
  • After successful removal of the foreign body, reexamine the rectum using the anoscope for any bleeding, tears, or for additional foreign bodies.
Also, see Foreign Body Removal, Rectum.

More on Foreign Bodies, Rectum

Overview: Foreign Bodies, Rectum
Differential Diagnoses & Workup: Foreign Bodies, Rectum
Treatment & Medication: Foreign Bodies, Rectum
Follow-up: Foreign Bodies, Rectum
Multimedia: Foreign Bodies, Rectum
References
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References

  1. Wagner J. Foreign bodies in the rectum. Am J Surg. 1937;36:266-269. [Medline].

  2. Smith MT, Wong RK. Foreign bodies. Gastrointest Endosc Clin N Am. Apr 2007;17(2):361-82, vii. [Medline].

  3. Clarke DL, Buccimazza I, Anderson FA, Thomson SR. Colorectal foreign bodies. Colorectal Dis. Jan 2005;7(1):98-103. [Medline].

  4. Stack LB, Munter DW. Foreign bodies in the gastrointestinal tract. Emerg Med Clin North Am. Aug 1996;14(3):493-521. [Medline].

  5. Rodriguez-Hermosa JI, Codina-Cazador A, Ruiz B, Sirvent JM, Roig J, Farres R. Management of foreign bodies in the rectum. Colorectal Dis. Jul 2007;9(6):543-8. [Medline].

  6. Janicke DM, Pundt MR. Anorectal disorders. Emerg Med Clin North Am. Nov 1996;14(4):757-88. [Medline].

  7. Rosser C. Colonic foreign bodies. JAMA. 1929;39:368-369. [Medline].

  8. Hellinger MD. Anal trauma and foreign bodies. Surg Clin North Am. Dec 2002;82(6):1253-60. [Medline].

  9. Lake JP, Essani R, Petrone P, et al. Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum. Oct 2004;47(10):1694-8. [Medline].

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Further Reading

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Keywords

object in rectum, rectal foreign body, rectal foreign object, rectal foreign bodies, rectal pain, rectal bleeding, rectal lacerations, rectal perforations, foreign body in the rectum

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Contributor Information and Disclosures

Author

David W Munter, MD, MBA, Assistant Clinical Professor of Emergency Medicine, Eastern Virginia Medical School; Medical Director, Emergency Medical Department, Sentara Obici Hospital; Partner, Emergency Physicians of Tidewater, LPC; President of the DESA Consulting Group
David W Munter, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, Medical Society of Virginia, and Norfolk Academy of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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