Overview of Rectum Foreign Body Removal
Having a foreign object stuck in the rectum is not a new incident. There have been cases reported even in the 16th century. Today, it’s becoming increasingly common to see such cases in emergency rooms, especially among city-dwellers. The average age of people experiencing this is around 44, and it’s seen more frequently in men.
Objects may get there due to a variety of reasons like sexual pleasure, hiding something (for instance, drug smugglers might use it as a hiding place), sexual assault or purely by accident. However, the most common cause is using different items for sexual gratification. The incidence of such cases has risen due to the increasing use of various objects for anal sex.
When such incidents happen, how quickly people seek medical help varies. Some people might immediately go to an emergency room because they can’t remove the object themselves. Others might delay seeking help for as long as two weeks because they’re embarrassed. Even when they do go to a hospital, they may not be upfront about what actually happened.
Several techniques exist for removing these foreign bodies, and these methods have improved over time thanks to technology. Today, doctors can use laparoscopy (a minimally invasive surgery using small incisions), endoscopy (using a flexible tube with a lighted camera to look inside your body), and other minimally invasive surgical options. All these procedures have their specific uses, potential complications, and importance in handling such cases, which will be explained in this article.
Anatomy and Physiology of Rectum Foreign Body Removal
The rectum is part of the digestive system, it comes after the sigmoid colon, which is part of the large intestine. It is a tube-shaped structure that starts around your tailbone, and becomes the anal canal, which is the last part of your digestive tract that ends at the anus. The rectum has two major bends, and three additional smaller bends. It’s supported from below by a muscle called the levator ani muscle, and supported from behind by a tissue called the fascia of Waldeyer. Other structures help support it from the sides and the front.
In terms of what else is near the rectum: to the back, it’s close to the sacral plexus and sympathetic trunks (two groups of nerves). To the front in men, it sits close to the bladder, prostate (a small gland that makes some of the fluid in semen), seminal vesicles (glands that also contribute to semen), and a small pocket called the rectovesical pouch. In women, the rectum is close to the uterus (where a baby grows during pregnancy), cervix (the lower part of the uterus), vagina, and a small pocket called the pouch of Douglas. These pockets contain parts of the large intestine and small intestine. The end of the digestive system, the anal canal, is supported by some fibromuscular structures, like the perineal body in front, and the anococcygeal body from behind.
Why do People Need Rectum Foreign Body Removal
If there’s a foreign object in someone’s rectum, it should be taken out right away. There are two ways to remove this object: from the bottom up, which is called a transanal approach, or from the top down, which is known as an abdominal approach.
Typically, doctors will attempt the transanal approach first. It’s possible to remove about 60% to 75% of foreign objects in the rectum this way. This method is generally used when the object is within about 4 inches (or 10 cm) from the edge of the anus and the patient doesn’t have any signs of a possible infection of the lining of the abdomen (peritonitis). However, if removing the object this way is too painful or too difficult due to swelling, the patient might need to be sedated to ease the pain.
If the patient shows signs of peritonitis, or the foreign object is not detectable through a doctor’s physical examination of the rectum with their finger (known as a digital rectal exam), then the removal will require an abdominal approach. This means the doctor will either use a laparoscope (laparoscopy), which is a thin tube with a camera that’s inserted through a small cut in the abdomen, or they’ll make a larger incision in the abdomen (laparotomy) to remove the foreign object.
When a Person Should Avoid Rectum Foreign Body Removal
There are definitely times when a doctor can’t use a transanal approach (a method where they reach the problem through your back passage) for a procedure. These include when:
– A rectal perforation (a hole in your rectum) has caused peritonitis, which is a dangerous infection in your abdomen.
– A person is showing signs of sepsis, which is a severe full-body reaction to an infection.
– Tests show there’s loose gas under the diaphragm (the muscle below your lungs that helps you breathe) in an upright chest x-ray, indicating a problem.
– There is free fluid in the abdomen, which shouldn’t be there.
Sometimes, a doctor may be able to use a transanal approach, but it might not be the best option. This is generally the case when:
– A problem can’t be felt with a finger during an exam of the back passage.
– A foreign body is stuck really badly due to swelling in the area.
– A foreign body is fragile or sharp, making it difficult or dangerous to remove.
– A patient is unable, or unwilling, to cooperate during the procedure.
Equipment used for Rectum Foreign Body Removal
For a procedure involving the removal of an object from the rectum or colon. Here are the items your doctor might use:
* Surgical gloves: This is standard for any procedure. They’re used to maintain cleanliness and prevent infections.
* Light source: This helps the doctor see what they’re doing.
* Lignocaine gel: This is a type of numbing gel that is used to help you stay comfortable during the procedure.
* Anal speculum: This instrument helps open up the rectum so that the doctor can see and reach the object.
* Foley catheter: This is a flexible tube that is used to empty the bladder during certain medical procedures.
* Vaginal speculum: This device is used in procedures involving women. Like the anal speculum, it helps open things up so that the doctor can see and do what they need to do.
* Proctoscope: Like the other speculums, this instrument helps doctors see inside the rectum. This can help them find and safely remove the foreign object.
* Grasping forceps: These are like long tweezers. Doctors use them to grab onto and remove the foreign object.
* Rigid or flexible sigmoidoscope: This is a tube-like device with a tiny camera on the end. The doctor might use it if they can’t feel the foreign object. It can help them see and reach things that are further up in the colon.
Who is needed to perform Rectum Foreign Body Removal?
Dealing with a foreign object in your rectum involves a group of healthcare professionals working together. This team is typically made up of a surgeon, a psychiatrist who acts as a connection point for the whole team, nurses, an anesthesiologist (a doctor who ensures you don’t feel pain during surgery), and an operation table assistant. Each of these individuals plays a significant role to help resolve the issue as efficiently and safely as possible.
Preparing for Rectum Foreign Body Removal
When a patient needs to be examined, it’s important they’re given a private space. This is because the doctor will need to touch and gently press on the stomach to check for any signs of internal injury, like extreme tenderness or a hard, tense stomach. If any of these signs are found, the patient may need to receive fluids through a vein, and the doctor might perform some blood tests. These include checking the number of blood cells, salt levels, blood clotting ability, and blood type.
If the patient appears very unwell, the doctor might take an additional sample to test for a substance in the blood called lactic acid, as high levels can sometimes indicate a serious infection. In that case, powerful antibiotics that treat a range of bacteria may be given, such as 3rd generation cephalosporins and metronidazole.
The doctor may also order a chest x-ray to be done while the patient is standing up. This can reveal if there’s any air in places it shouldn’t be, which might suggest a tear or hole in an organ. Additionally, an abdominal x-ray might be done to see if there’s any object stuck inside the digestive tract, although this only works if the object is visible on x-rays.
If the doctor needs to physically remove the object, pain relief and maybe sedative drugs should be ready to use. Most importantly, the doctor should talk to the patient about the potential advantages and disadvantages of all the procedures so they are informed and can agree to them.
How is Rectum Foreign Body Removal performed
Having a foreign object stuck in the rectum is a medical emergency. There are many ways to remove these objects, just as there are many different types of objects that can get stuck.
Generally, doctors will start with the least intrusive methods and move to more complex ones if needed. Most of the time, foreign objects can be removed without surgery. A typical method is to use pain relief, sedation or anesthesia, and then try to manually remove the object. This might happen in the operating room. Success in manual removal can depend on the size of the health care provider’s hand size and how relaxed the muscles around the rectum are. Patients might be asked to bear down as if they are having a bowel movement to help push the object out. Manual removal should not be attempted if there are signs of a hole or serious inflammation in the bowel, or if the object is sharp, as this could lead to injury for both the patient and the provider.
People who have swallowed drug packets pose particular risks. It’s best to remove these objects, which could leak toxic substances, in the operating room.
A medical balloon on a tube, called a Foley catheter, can also be useful in removing objects. The tube is inserted past the object to allow air to pass, breaking any vacuum seal that might have formed. Inflating the balloon can help remove the object. Other tools, such as clamps often used in childbirth, might also be used, but could be difficult if the object is smooth.
Other techniques include:
* Using magnets to remove metal objects.
* Special clamps to break up objects, like fruit or vegetables, into smaller pieces that are easier to remove.
* Inflating a medical tube, such as Sengstaken-Blakemore tube, inside objects like bottles or jars to get a better grip on the object.
* Using a medical suction device, sometimes used in childbirth.
Sometimes, if the object can’t be removed in a simpler way, more advanced techniques are needed. This will often happen in the operating room, since deeper levels of sedation and muscle relaxation can be achieved. If the object is lodged beyond the first part of the colon, surgical intervention is often required. The object might be removed using a long, flexible medical instrument called a sigmoidoscope, which also allows the rectum to be checked for damage after removal.
Another technique is transanal minimally invasive surgery (TAMIS), in which a special surgical instrument is inserted through the anus to remove the object.
For more complex cases, objects might be moved towards the rectum for removal using laparoscopy, a surgical procedure, or laparotomy, an open surgery. If there’s a suspected hole in the bowel, part of the bowel might be bypassed through a colostomy, a surgically created hole in the abdomen for waste removal. The severity of the patient’s condition will determine the best course of action.
Possible Complications of Rectum Foreign Body Removal
The rectum, part of your digestive system, is in a space in your body that’s tightly packed with other parts of your body. Because of this close proximity to other structures and its curved shape, it can be injured if it gets punctured by foreign objects. One of the scariest complications that can occur if a foreign object pierces the rectum is peritonitis, a dangerous and often painful inflammation of the abdomen’s lining.
If the pierced part of the rectum is contained and doesn’t leak into the rest of the abdomen, an abscess, which is a pocket of pus, can form locally. Sharp foreign objects can also injure other nearby body parts like the urinary bladder or vagina, causing abnormal connections called vesicorectal (between bladder and rectum) and rectovaginal (between vagina and rectum) fistulas.
If a foreign object stays in the rectum for too long, it can cause problematic symptoms such as bleeding, the formation of ulcers (wounds), blockages, and widespread infection, also known as sepsis.
What Else Should I Know About Rectum Foreign Body Removal?
It is important to promptly remove any foreign objects swallowed or stuck inside the body. If not taken out quickly, it can lead to swelling (edema) and can even tear open (perforate) the colon (large intestine). This can result in the need for a complex surgery to remove the foreign object from your abdomen.
