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Foreign Objects in the Rectum

By Parswa Ansari, MD, Assistant Professor and Program Director in Surgery, Hofstra Northwell - Lenox Hill Hospital, New York

Foreign objects in the rectum are usually objects that have been inserted into the rectum but also may have been swallowed.

  • Objects that have been inserted into the rectum intentionally or swallowed may become stuck.

  • Symptoms depend on the size and shape of the object and whether there are any complications.

  • The diagnosis is based on a physical examination, x-rays, and computed tomography.

  • If the doctor is not able to remove the object with a retractor, it is removed surgically.

The rectum is the section of the digestive tract above the anus where stool is held before it passes out of the body through the anus. The anus is the opening at the end of the digestive tract where stool leaves the body.

The Digestive System

Swallowed objects, such as toothpicks, chicken bones, or fish bones, may become stuck at the junction between the anus and rectum (called the anorectal junction). Also, enema tips, surgical sponges or instruments, thermometers, and objects used for sexual stimulation may become stuck unintentionally in the rectum after being passed through the anus. Drug packets inserted in an attempt to conceal them from law enforcement officials may be inserted intentionally but become stuck unintentionally.

Symptoms

Sudden, excruciating pain during bowel movements suggests that a foreign object, usually at the anorectal junction, is penetrating the lining of the anus or rectum. Other symptoms depend on the size and shape of the object, how long it has been there, and whether it has perforated (pierced) the anus or rectum or caused an infection.

Diagnosis

  • A doctor's examination

  • Examination of the abdomen and chest x-rays

A doctor may be able to feel the object by probing with a gloved finger during an examination.

X-rays of the abdomen and chest can help doctors identify the object and determine whether complications have occurred. Computed tomography (CT) may be done if the object cannot be identified with x-rays.

Treatment

  • If the object can be felt, removal by rectal retractor

  • If the object cannot be felt or seen, removal by surgery

  • After removal, sigmoidoscopy

If a doctor can feel the object, a local anesthetic is usually injected under the skin and lining of the anus to numb the area. The anus can then be spread wider with an instrument called a rectal retractor, and the object can be grasped and removed. Sometimes doctors give general anesthesia, which relaxes the anus and allows the object to be removed without surgery.

If a doctor cannot feel the object or if the object cannot be seen and removed through the anus, the doctor waits until the natural wave-like movements of the wall of the large intestine (called peristalsis) bring the object down, making removal possible.

If the doctor is unable to remove the foreign body, the person is hospitalized and surgery is needed. During surgery, the person is given a regional or general anesthetic and the object is gently moved toward the anus. Rarely, the rectum needs to be cut open to remove the object.

After the object is removed, the doctor does a sigmoidoscopy (a flexible tube is inserted into the anus to view the lower portion of the large intestine, the rectum, and the anus) to determine whether the rectum has been perforated or otherwise injured.

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