An object is generally inserted by the patient or a partner for
sexual stimulation; then it causes pain or bleeding or becomes irretrievable. There may be rectal or lower abdominal pain, obstipation or acute urinary retention. Sometimes the patient will not volunteer that any object has been inserted, or give
outlandish explanations such as having sat or fallen onto the object.
When interviewed privately, however, the patient will usually give an
accurate accounting of the foreign body.
What to do:
Perform an abdominal and rectal exam. If there are signs of peritoneal inflammation, such as rebound tenderness or pain with movement, a perforation of the bowel should be suspected, and you should start appropriate intravenous lines, draw blood for laboratory analysis, obtain flat and upright abdominal x rays to look for free air, notify surgical consultants and administer intravenous antibiotics.
If there are no signs of perforation, still obtain flat and upright abdominal films to help define the nature, size, and number of foreign objects (as well as to reveal unsuspected free air).
Sedate the patient with intravenous benzodiazepines and narcotics to help in the removal of the foreign body. Place the patient on his side in the Sims position. If anal discomfort persists, instill lidocaine jelly for mucosal anesthesia or locally infiltrate 1% lidocaine with epinephrine. The method of removal must be individualized depending on the size, shape, consistency and fragility of the object.
When the object can be reached by the examining finger and it is of a nature that will allow it to be grasped, a lax anal sphincter may allow you slowly to insert as much of your gloved hand as possible to grab the object and gradually extricate it. Perforate fruit with your fingertips.
If you are unable to pull out the foreign body with your hand, there are a number of techniques that can be used to get a purchase on the object and break the vacuum behind it:
Slide a large Foley catheter with a 30cc balloon past the
object, inflate the balloon, and apply traction to the
catheter. (This can be used in conjunction with any of the
other techniques.) Two catheters may occasionally be needed and air can be instilled through the lumen of the catheter.
Under direct visualization with an anoscope or vaginal
speculum, you can attempt to grasp the object with a
tenaculum, sponge forcep, Kelly clamp or tonsil snare.
An open object, like a jar or bottle, can be filled with
wet plaster, into which a tongue blade can be inserted like
a popsickle stick. When the plaster hardens, traction can be
applied to the tongue blade.
Forceps or soup spoons can be used to "deliver" a round
With an object that is too high to reach, the patient can be
admitted and sedated for removal the next day.
When the object cannot be removed due to patient discomfort
or sphincter tightness, then removal must be accomplished in
the OR under spinal or general anesthesia.
When blood is present in the rectum or the object is capable of
doing harm to the bowel, then sigmoidoscopy should be performed after
removal of the foreign body. When pain persists or there is any
lingering suspicion of a bowel perfortion, keep the patient for
What not to do:
Do not pressure the patient into giving you an accurate
story. He may be embarrassed and intimidation will not help.
Do not push the object higher into the colon while attempting
to remove it.
Do not blindly grab for an object with a tenaculum or other
such device. This can itself lead to a perforation.
Do not attempt to remove sharp, jagged objects such as broken
glass via the rectum. These should only be removed under
anesthesia in the OR.
Do not send a patient who is having continued pain home.
Admit him and observe for peritoneal signs, increased pain,
fever, and a rising white count.
Most rectal foreign bodies (vibrators, dildos, broom handles,
bottles, lightbulbs, balls, fruits, and vegetables) can be removed
safely in the emergency department. Some practitioners quite
reasonably forego x rays prior to manipulation if the patient is
free of pain and fever. The famous gerbil is urban folklore. Consider recommending sexual or psychological counselling.
Couch CH, Tan EGC, Watt AG: Rectal foreign bodies. Med J Aust 1986;144:512-515.