Rectal foreign bodies are usually objects that have been inserted into the rectum but also may have been swallowed. Sudden and excruciating pain during defecation can be caused by a foreign body penetrating the anorectal wall. Diagnosis is by digital examination and sometimes imaging studies. Removal of a rectal foreign body may be of high risk and should be done by a surgeon or gastroenterologist skilled in foreign body removal. Gallstones, fecaliths, and swallowed foreign bodies including toothpicks and chicken and fish bones may lodge at the anorectal junction. Urinary calculi, vaginal pessaries, or surgical sponges or instruments may erode into the rectum. Some objects are caught in the rectal wall, and others are trapped just above the anal sphincter.
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Correspondence to: Dr. 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.
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Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The approach includes a careful history and physical examination, a high index of suspicion for any evidence of perforation, a creative approach to nonoperative removal, and appropriate short-term follow-up to detect any delayed perforation. Objectives: After completion of this article, the reader should understand the current evaluation and therapeutic management for patients with rectal foreign bodies. Rectal foreign bodies have a storied history as part of anorectal trauma. The first described report on the management of retained rectal foreign bodies dates back to the 16 th century, 1 , 2 and the first case reports of the modern era were published in Here we will review and describe the current elements of diagnosis, evaluation, and treatment of the inserted rectal foreign body.
These are often caused by the insertion of foreign bodies into the rectum or other rectal sexual injury. Different civilisations throughout history have dealt with anal sex in different ways ranging from accepting it as a normal practice to condemning it as an abomination to be punished. Although condemned in biblical times and punishable by death by burning in the Middle Ages, homosexual sex was commonplace in Roman and ancient Greek societies Irizarry and Gottesmann, Over the past 20 years many western societies have become more tolerant towards homosexuality, and this may have contributed to increased sexual permissiveness among the homosexual community. Numerous substitutes, mainly phallic, have been used for anorectal eroticism, sometimes with serious consequences including death Cohen and Sackier, According to Crass et al , the only limitation to the variety of objects used is the capacity of the rectum to accommodate them, and a vast number of different items are reported to have been recovered from the rectum Box 1. One of the most intriguing reports, cited by Irizarry and Gottesman , describes how the contents of an entire toolbox were found at autopsy in a prisoner who died of bowel obstruction. Although the main reason for insertion appears to be autoeroticism the literature also contains information pertaining to insertion by sexual partners; during assaults; as a remedy for constipation Fig 1 and other ailments; drug smuggling; ingested objects and falling on objects. Although the incidence of rectal foreign bodies being retained is not known, their use for anal eroticism appears to be increasing Shah et al, ; Irizarry and Gottesman, The predominant group presenting to hospital is male ratio , as foreign body insertion in females is often vaginal.