Anorectal Foreign Body Removal

imagesAnorectal foreign body (FB) in a stable, cooperative patient, which is:

   imagesPalpable by rectal approach

   imagesAbsence of a sharp edge


imagesObtain surgical consult immediately in following instances:

   imagesSigns of perforation, obstruction, or severe abdominal pain

   imagesNonpalpable FB

   imagesBroken glass in rectum

   imagesUncooperative or intolerant patient

   imagesLack of equipment necessary for retrieval

imagesGeneral Basic Steps

   imagesDetermine type of FB


   imagesObtain necessary equipment

   imagesPatient preparation


   imagesFB removal

   imagesAssess for structural damage


imagesIngestion (e.g., bones, toothpicks) versus rectal insertion

imagesSize and composition of FB

imagesTime of ingestion/insertion

imagesAttempts made to remove FB

imagesAssess for red flags—fever, abdominal pain, hematochezia

imagesAssess for sexual/physical assault, sexually transmitted disease (STD) risk


imagesDetermine the orientation, location, and composition of the anorectal FB and, thereby the appropriate approach to removal by the following:

   imagesDetailed history

   imagesConsider radiography

      imagesKidney, ureter, and bladder (KUB) x-ray

      imagesChest x-ray for free air detection (if concerned about perforation)

   imagesPhysical examination, including digital rectal examination (DRE)

imagesVisualization of the anorectum is enhanced with the patient in the lateral decubitus position, lithotomy position, or prone with knees tucked into chest



   imagesDepends on the composition and locale of the FB but may include:


      imagesLight source

      imagesSpeculum (i.e., vaginal speculum or anoscope) or Parks retractor to improve visualization

      imagesRing and/or tenaculum forceps

      imagesFoley catheter and/or endotracheal tube (ETT)

      imagesVacuum extractor

imagesPatient Preparation

   imagesGet informed consent detailing risks, benefits, and alternatives

   imagesOrder KUB x-ray to localize and define FB, and to assess for obstruction or perforation if clinically necessary (FIGURE 83.1)

   imagesParenteral sedation and analgesia to enable relaxation and tolerance of the procedure. Avoid oversedation because the patient must be alert to assist in the delivery of the FB.

   imagesPlace the patient in the desired position

   imagesA perianal block may facilitate further sphincter relaxation. This is achieved by superficial injection of local anesthetic (≤1.5 mg/kg of 0.5% bupivacaine or ≤7 mg/kg of 1% lidocaine with 1:100,000 epinephrine) in a ring around the anus.


   imagesExternal examination: Assess for signs of trauma


      imagesGauge location and orientation of FB

      imagesAssess for discharge or bleeding

      imagesSmall, blunt FBs may be removed during DRE


      imagesAssess for mucosal injury

      imagesVisualize FB

imagesRemoval of FB

   imagesAttempt delivery of the FB by applying suprapubic pressure in synchrony with the patient bearing down


FIGURE 83.1 X-ray of a retained rectal vibrator. (Courtesy of Heather Huffman–Dracht.)

Only gold members can continue reading. Log In or Register to continue

Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Anorectal Foreign Body Removal
Premium Wordpress Themes by UFO Themes