Approach Considerations
Before extraction is attempted, intravenous (IV) pain control medications and benzodiazepines should usually be administered. A perianal block may be considered. Formal procedural sedation may also be considered. Continuous electrocardiographic (ECG) and vital sign monitoring should be performed. Enemas, laxatives, and cathartics should not be used routinely to aid in removal of a foreign body.
Extraction of Foreign Body From Rectum
Instruct the patient to assume the desired position (see Patient Preparation). First, attempt to remove the object by means of digital manipulation alone; this often proves possible. If the patient is kept alert enough, he or she can perform the Valsalva maneuver to assist with the procedure.
If the object cannot be successfully removed with digital manipulation, insert a retractor or speculum device. If the object is then visible, grasp its edge under direct visualization. Never attempt to grasp an unseen object: doing so may pinch the rectal mucosa and thereby cause further injury. If the object cannot be visualized with a retractor instrument in place, consult a surgeon.
If a glass object is being grasped, pad the ends of the forceps to avoid breakage. Apply steady, gentle traction on the forceps to withdraw the object. Suprapubic pressure may assist with object removal. The object may have to be redirected around the sacral curve. Have the patient bear down; this may facilitate removal. If the object is too large to be withdrawn through the speculum, the foreign body and the speculum may have to be removed en bloc.
If suction created by the rectal mucosa is hindering withdrawal, a Foley catheter may be advanced proximal to the object and the balloon inflated to break the suction. The Foley catheter can then be used as an additional traction device to aid in removal.
If the foreign body cannot be removed safely, consultation with a surgeon or gastroenterologist is warranted. The patient may require an examination under general anesthesia for removal, an endoscopic removal, or a laparotomy for removal. [15, 16, 17] Cases in which the foreign body was removed with a transanal technique using a single port have been reported. [18, 19, 20]
A few less common methods have been used for successful removal of rectal foreign bodies, including the use of a vacuum-extractor device, plaster of Paris, and obstetric forceps. Balloon extraction is sometimes employed. [21] The use of laparoscopic specimen extraction bags has been described. [22]
Postprocedural Care
Once the object is removed, sigmoidoscopy or colonoscopy should be considered for detection of possible mucosal injury. If more severe injury or perforation is suspected, surgical consultation is needed. If only superficial mucosal injury is found, consideration should be given to discharging the patient in conjunction with a surgical consultation. If no injury is found, the patient may be discharged home after observation in the emergency department (ED).
Discharge instructions should include warning signs for perforation, infection, and bleeding. The patient should understand that he or she needs to return to the ED if these signs or symptoms develop.
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Ring forceps.
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Tenaculum forceps.
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Vaginal speculum (closed).
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Vaginal speculum (open).
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Rectal speculum (closed).
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Rectal speculum (open).
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Rectal speculum (closed).
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Rectal speculum (open).
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Hill-Ferguson retractor.
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Rectal foreign body that is difficult to observe on radiography.
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Rectal foreign body readily visible on radiography.
