Rectal Foreign Bodies Clinical Presentation

Updated: Dec 28, 2015
  • Author: David W Munter, MD, MBA; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Presentation

History

Patients with rectal foreign bodies are usually aware of their presence and often present requesting removal. They may also present with rectal pain or bleeding and, less often, abdominal pain. [8, 10] More serious complaints indicative of perforation include fever, vomiting, or severe abdominal or rectal pain. [6, 11]

Patients who have ingested foreign bodies that become lodged in the rectum may present with rectal pain or bleeding, constipation, pain with defecation, pruritus, or diffuse abdominal pain. Symptoms of peritonitis or bowel obstruction also may be present. The usual etiologic objects are sunflower seeds, toothpicks, or bones, and the ingestion is typically unknown. [5] Fecal impaction should be considered.

Patients with rectal foreign bodies may be too embarrassed to mention the foreign body at triage but usually admit the etiology to the physician. Maintain a high suspicion index of rectal foreign body in psychiatric patients or prisoners who present with rectal pain or bleeding. [9, 7]

The vast majority of patients with rectal foreign bodies present because of an inability to remove the object. Some patients claim to have sat or fallen on the object. Older patients may state they were engaged in therapeutic prostatic massage or breaking up fecal impactions when the object was lost. Occasionally, objects such as thermometers or enema tips may become lost. Most patients, however, admit to a history of self-insertion or insertion by a partner. [1]

Typically, multiple failed attempts at self-removal have occurred. Ascertaining whether the patient attempted any instrumentation in these attempts is important because the use of instruments increases the risk of perforation or laceration. The length of time since insertion and the presence of rectal or abdominal pain, fever, or rectal bleeding are important elements of the history. The type of object should be determined because fragile or sharp foreign bodies deserve special consideration. [6, 10]

Patients should be asked if the foreign body is the result of assault because serious injury is more likely in this scenario. Depending on local laws, notify the legal authorities if the patient has been assaulted, and if local laws require this, the patient agrees to such notification.

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Physical Examination

Assess vital signs and general appearance. Fever or hypotension may indicate infection or bleeding. Perform an abdominal examination. Absent bowel sounds, rigidity, or peritoneal signs suggest perforation. The foreign body, especially if large or in a high-lying position, can occasionally be palpated.

A rectal examination should be deferred in patients with known or suspected rectal foreign bodies, especially in prisoners or psychiatric patients, until the location and type of foreign body has been ascertained radiographically. In some cases, dangerous objects such as guns or sharp objects (eg, needles, razor blades) are inserted rectally in an attempt to hide the object or, in the case of psychiatric patients, to injure the examiner. [9] The main purpose of the rectal examination is to check for the presence of blood and the position of the foreign body.

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Complications

The most common complications of rectal foreign bodies are rectal laceration and perforation, which are diagnosed by direct visualization. Questionable cases should be referred to a general surgeon. Other complications that may be seen include infection with abscesses and sepsis.

All cases of suspected laceration or perforation should be treated by administering a broad-spectrum antibiotic such as piperacillin-tazobactam.

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