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Frendt E, Masroor M, Saied A, Neeki A, Youssoffi S, Malkoc A, Dong F, Tran L, Borger R, Wong DT, Neeki M. Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis. Cureus 2023; 15:e49413. [PMID: 38149151 PMCID: PMC10750084 DOI: 10.7759/cureus.49413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.
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Affiliation(s)
- Eric Frendt
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Momin Masroor
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arman Saied
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Arianna Neeki
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Santana Youssoffi
- Emergency Department, California University of Science and Medicine, Colton, USA
| | - Aldin Malkoc
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Fanglong Dong
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Louis Tran
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - Rodney Borger
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
| | - David T Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Michael Neeki
- Emergency Department, California University of Science and Medicine, Colton, USA
- Emergency Department, Arrowhead Regional Medical Center, Colton, USA
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Kim JH, Um E, Jung SM, Shin YC, Jung SW, Kim JI, Heo TG, Lee MS, Jun H, Choi PW. The Management of Retained Rectal Foreign Body. Ann Coloproctol 2020; 36:335-343. [PMID: 32054243 PMCID: PMC7714380 DOI: 10.3393/ac.2019.10.03.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience. Methods We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes. Results All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling. Conclusion Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.
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Affiliation(s)
- Ju Hun Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Myung Soo Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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McCombe AJ, Frankel AJ, Morris B. Pneumatic oscillating microsagittal saw: a novel method for removal of a rectal foreign body. ANZ J Surg 2018; 89:E446-E447. [PMID: 29895101 DOI: 10.1111/ans.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Adam J Frankel
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bradley Morris
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Abstract
Foreign bodies in the rectum are commonly confronted worldwide in the surgical emergency. Such a situation arises either accidentally or for autoerotic purposes. A wide variety of foreign objects have been reported in the literature and this usual object would add to the reports for its unusual location. We report a case of a 26-year-old young man with accidental insertion of hand shower in the rectum and no signs of any active bleed or peritonism. Extraction was done successfully in the operating room under general anaesthesia, with an uneventful postprocedure period and the patient was discharged after 48 hours of observation. Rectal foreign bodies can be of wide variety and can lead to life-threatening conditions. An orderly approach is required for diagnosis, management and evaluation in the postprocedure period.
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Affiliation(s)
- Peeyush Kumar
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Samar Rehman
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Anil Kumar Singh Rana
- Department of Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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Cawich SO, Thomas DA, Mohammed F, Bobb NJ, Williams D, Naraynsingh V. A Management Algorithm for Retained Rectal Foreign Bodies. Am J Mens Health 2017; 11:684-692. [PMID: 27903951 PMCID: PMC5675215 DOI: 10.1177/1557988316680929] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 01/25/2023] Open
Abstract
Few authors have proposed therapeutic protocols to manage retained rectal foreign bodies (RFBs). All patients with retained RFBs in hospitals across Trinidad and Tobago over 5 years were identified. Hospital records were retrieved and manually reviewed to extract the following data: demographics, history, foreign body retrieved, clinical signs at presentation, management strategy, duration of hospitalization, and morbidity and mortality. There were 10 patients with RFBs over the study period. The annual incidence of this phenomenon was 0.15 per 100,000 population. All patients were men at a mean age of 50.6 years (range: 27-83; SD = 15.3) who presented after a voluntary delay of 1.4 days (range: 0.5-2.5; SD = 0.7). Only one patient gave an accurate history on presentation, but all eventually admitted to self-insertion for sexual gratification. At presentation, one patient had a spontaneous rectal perforation (10%). The remaining nine patients had attempts at bedside transanal extraction, which was unsuccessful in 89% (8/9) of cases. The RFB was pushed beyond the grasp of forceps, making removal under anesthesia unsuccessful in 62.5% (5/8) cases. These patients required more invasive extraction methods including transanal minimally invasive surgery (1), laparoscopic-assisted advancement with transanal retrieval (1), and open surgery with transmural extraction and anastomoses (3). A management algorithm is proposed for the management of RFBs. Important points in this algorithm are the importance of clinician-patient rapport, early surgical referral, avoidance of bedside extraction in the emergency room, early examination under anesthesia, and the inclusion of emerging therapies such as transanal minimally invasive surgery.
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Affiliation(s)
- Shamir O. Cawich
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Dexter A. Thomas
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fawwaz Mohammed
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nahmorah J. Bobb
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Dorothy Williams
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- The University of the West Indies, St. Augustine, Trinidad and Tobago
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Abstract
AIM to present the results of treatment of rectal foreign bodies. MATERIAL AND METHODS 15-year outcomes of 112 patients with rectal foreign bodies were analyzed. RESULTS Outpatient and hospital care were applied in 52 (46%) and 60 (54%) of cases respectively. Transanal removal was made in 97 (87%) patients including 28 (25%) cases of general anaesthesia. 14 (13%) patients underwent surgery. Colostomy was performed in 7 (6%) cases. We presented cases of foreign bodies removal through laparotomy, colotomy and SILS-assisted transanal approach. DISCUSSION From clinical point of view foreign bodies should be first of all classified by their dimensions. Anamnesis and physical examination are very important. Abdominal X-ray survey is obligatory. Transanal removal under general anaesthesia is advisable if perforation is absent. If such procedure is impossible laparotomy is indicated. CONCLUSION Algorithm of survey and treatment is presented.
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Affiliation(s)
- D A Khubezov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - S N Trushin
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - K V Puchkov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - D K Puchkov
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
| | - A Yu Ogorel'tsev
- Pavlov Ryazan State Medical University, Health Ministry of the Russian Federation ,Regional Clinical Hospital, Ryazan, Russia
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Sayın B, Polattaş P, Akdal Dölek B, Yıldırım N, Dede D. Twelve month delay in emergency department presentation of a patient with a rectal foreign body. Emerg Med Australas 2012; 24:683. [PMID: 23216735 DOI: 10.1111/1742-6723.12003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kasotakis G, Roediger L, Mittal S. Rectal foreign bodies: A case report and review of the literature. Int J Surg Case Rep 2011; 3:111-5. [PMID: 22288061 DOI: 10.1016/j.ijscr.2011.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 11/26/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Rectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful. PRESENTATION OF CASE In this article we report the case of a male who presented with a large ovoid rectal object wedged into his pelvis. As we were unable to extract the object with routine transanal and laparotomy approach, we performed a pubic symphysiotomy that helped widen the pelvic inlet and allow transanal extraction. DISCUSSION We review currently available literature on RFB and propose an evaluation and management algorithm of patients that present with RFB. CONCLUSION Management of patients with rectal foreign bodies can be challenging and a systematic approach should be employed. The majority of cases can be successfully managed conservatively, but occasional surgical intervention is warranted. If large objects, tightly wedged in the pelvis cannot be removed with laparotomy, pubic symphysiotomy should be considered.
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Affiliation(s)
- G Kasotakis
- Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States
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Abstract
AIM To perform a systematic review of the published reports on retained colorectal foreign bodies (CFBs) to collate the features and formulate a simple management plan based on the available evidence. METHOD An extensive search was carried out to identify articles on CFBs. The search was carried out on electronic databases Cinahl, Embase, Medline, PubMed and PsychInfo from 1950 to January 2009. Internet journals were also scoured and a general search was carried out using the search engine 'Google'. Papers published in languages other than English were not included. RESULTS This review covers a total of 193 patients with 196 presentations. There were 188 men and 5 women, a ratio of approximately 37:1. The mean age at presentation was 44.1 years (SD 16.6) in the single case reports and 39.3, 40 and 60.8 years in the three case series. Household objects, such as bottles and glasses, accounted for the largest percentage (42.2%) of inserted objects. Presentation for treatment occurred most often within 24 h of insertion and the majority of objects were removed transanally using manual manipulation with or without the use of a variety of tools, or via a scope. CONCLUSIONS The incidence of CFBs is disproportionately higher in men. Various techniques for removal are available, including some that are minimally invasive. The appropriate technique will depend on the size and surface of the retained object and the presence of complications such as perforation or obstruction.
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Affiliation(s)
- M A Kurer
- Department of General Surgery, Colorectal Unit, York Hospital, York, UK
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10
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Abstract
Rectal foreign bodies present a difficult diagnostic and management dilemma because of delayed presentation, a variety of objects, and a wide spectrum of injuries. An orderly approach to the diagnosis, management, and post-extraction evaluation of the patient with a rectal foreign body is essential. This article outlines and describes the stepwise evaluation and management of the patient with a rectal foreign body. The authors also describe the varied techniques needed to successfully remove the different foreign bodies that may be encountered.
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11
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Abstract
A number of techniques have been described to remove rectal foreign bodies. In this report, a novel endoscopic technique using a pneumatic dilatation balloon normally used in achalasia patients is presented. In addition, a systematic review of the literature was performed for non-operative methods to remove foreign bodies from the rectum. These results are summarised, presented as a practical at-a-glance overview and a flow chart is offered to guide the clinician in treatment decisions. The design of the flow chart was based on the aims to treat the patient preferably on an outpatient basis with minimally invasive techniques and if possible under conscious sedation rather than general anaesthesia.
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12
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Abstract
Rectal foreign body insertion is an increasingly common surgical dilemma that requires thorough history, physical examination, radiographs and inventiveness to treat. Additionally the surgeon should demonstrate a sympathetic and caring attitude. This case report highlights the successful surgical management of a rare and bizarre case of extensive intraperitoneal injuries due to a wire inserted by the patient to retrieve a rectal foreign body introduced for sexual gratification.
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Affiliation(s)
- Arjun Singh Sandhu
- Department of Urology, Command Hospital (Southern Command), Pune, Maharashtra, 411 040 India
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