eMedicine Specialties > Emergency Medicine > Gastrointestinal

Foreign Bodies, Rectum: Follow-up

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

Follow-up

Further Inpatient Care

  • Arrange for evaluation and treatment of patients who are not candidates for ED removal and for patients with suspected rectal lacerations or perforations. Patients with subsequent noncomplicated operating room removal are typically discharged after recovery.

Further Outpatient Care

  • Refer most patients who have had ED extraction to a general surgeon for follow-up in 24-48 hours. Some patients with simple extractions can be reevaluated in the ED in 24-48 hours.

Inpatient & Outpatient Medications

  • Discharge patients on oral analgesics, such as nonsteroidal anti-inflammatory drugs or narcotic medications, as indicated. Antibiotics generally are not indicated in patients discharged home from the ED.

Complications

  • The most common complications are rectal laceration and perforation, which are diagnosed by direct visualization. Refer questionable cases to a general surgeon. Other complications include infection with abscesses and sepsis. Treat all cases of suspected laceration or perforation with a broad-spectrum antibiotic such as piperacillin-tazobactam.

Prognosis

  • The prognosis for the vast majority of rectal foreign bodies is excellent. 
  • For foreign bodies that result in perforation of the rectal or colon wall, the prognosis is also good with the use of antibiotics and operative intervention. 
  • Deaths in patients with rectal foreign bodies are rare and are almost always the result of perforation with prolonged delay until presentation for care.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Because of embarrassment, patients sometimes use false names or identification.
  • After extraction, patients with rectal foreign bodies sometimes elope from the ED.
  • Ensure privacy and confidentiality for the patient. In some cases, patients do not want any bills generated and offer to pay in cash to avoid an insurance paper trail. Attempt to fulfill their requests.
  • Do not perform a rectal examination, especially in prisoners or psychiatric patients, until number, type, and location of the rectal foreign body is ascertained radiographically. This helps to avoid patient or examiner injury from sharp or dangerous objects (eg, guns, needles, razors).
 


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

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  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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