Rectal foreign body: Difference between revisions
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==Background== | ==Background== | ||
*Make sure that object is not sharp before exam | |||
*Injuries may consist of hematoma, lacerations (with potential perforation) | |||
*Injuries may consist of hematoma, lacerations ( | |||
==Clinical Presentation== | ==Clinical Presentation== | ||
*Rectal pain and/or fullness | *Rectal pain and/or fullness | ||
*History of rectal foreign body placement | *History of rectal foreign body placement | ||
*Most are in the rectal ampulla and therefore palpable on digital examination | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 24: | Line 24: | ||
===ED removal=== | ===ED removal=== | ||
''Suitable for non-sharp objects that are in the distal rectum'' | ''Suitable for non-sharp objects that are in the distal rectum'' | ||
*IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's | #Sedation | ||
#*IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's | |||
*Anal lubrication | #*Local anesthesia (perianal block) will relax the anal sphincter and may be needed. | ||
*In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation. | #Manual removal | ||
*If obstetric forceps needed, | #*Anal lubrication | ||
*Large bulbar objects create a vacuum-like effect | #*In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation. | ||
**Break vacuum by passing foley behind object, inject air and pull foley out (balloon up) | #*If obstetric forceps needed, patient should bear down as object is extracted. | ||
#*Large bulbar objects create a vacuum-like effect | |||
#**Break vacuum by passing foley behind object, inject air and pull foley out (balloon up) | |||
===Surgical Consultation Indications=== | ===Surgical Consultation Indications=== | ||
| Line 37: | Line 38: | ||
*ED attempts fail | *ED attempts fail | ||
*Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia) | *Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia) | ||
==Disposition== | |||
*Consider observation for at least 12hr if concern for rectal perforation | |||
==See Also== | ==See Also== | ||
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*[[Foreign bodies]] | *[[Foreign bodies]] | ||
== | ==References== | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 10:32, 21 January 2016
Background
- Make sure that object is not sharp before exam
- Injuries may consist of hematoma, lacerations (with potential perforation)
Clinical Presentation
- Rectal pain and/or fullness
- History of rectal foreign body placement
- Most are in the rectal ampulla and therefore palpable on digital examination
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Diagnosis
Foreign body noted in rectum on lateral abdominal xray
- Abdominal xray
- Demonstrate position, shapes, and number of foreign bodies
- Demonstrates possible presence of free air (perforation of rectum or colon)
- Perf of rectum below peritoneal reflection shows extraperitoneal air along psoas
- Perf above peritoneal reflection reveals intraperitoneal free air under diaphragm
- CT
- Useful when foreign body is radiolucent and for detection of free air
Management
ED removal
Suitable for non-sharp objects that are in the distal rectum
- Sedation
- IV sedation and analgesia usually needed for adequate relaxation for removal of larger FB's
- Local anesthesia (perianal block) will relax the anal sphincter and may be needed.
- Manual removal
- Anal lubrication
- In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
- If obstetric forceps needed, patient should bear down as object is extracted.
- Large bulbar objects create a vacuum-like effect
- Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
Surgical Consultation Indications
- Removal could injure the sphincter
- ED attempts fail
- Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
Disposition
- Consider observation for at least 12hr if concern for rectal perforation