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Rectal foreign body

Key sources
The following summarized guidelines for the evaluation and management of rectal foreign body are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2021).
1

Guidelines

1.Diagnostic investigations

Clinical examination
Consider eliciting a focused medical history and performing a complete physical examination in patients with suspected retained anorectal foreign body.
C
Consider performing DRE after the acquisition of an abdominal X-ray, whenever possible, in patients with suspected retained anorectal foreign body to prevent accidental injury to the surgeon from sharp objects.
C
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  • Diagnostic imaging

  • Laboratory tests

2.Diagnostic procedures

Sigmoidoscopy: consider performing proctoscopy or flexible sigmoidoscopy after foreign body removal to evaluate bowel wall status in patients with retained anorectal foreign body.
C

3.Medical management

Antibiotics
Avoid using routine antimicrobials in patients with retained anorectal foreign body.
D
Administer broad-spectrum antibiotics according to the WSES guidelines on intra-abdominal infections in patients with retained anorectal foreign body and signs of hemodynamic instability or perforation.
B

4.Therapeutic procedures

Bedside transanal extraction: consider performing bedside extraction as first-line therapy in patients with low-lying retained anorectal foreign body without signs of perforation.
C
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  • Endoscopic extraction

  • Laparoscopic extraction

5.Surgical interventions

Surgical extraction, indications: consider performing surgery in patients with retained anorectal foreign body and without signs of perforation, if transanal extraction was failed.
C
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  • Surgical extraction (closure)