

Cecum and you shall find 'em

Time : Emotion / Activity

Removal

Suction is the enemy. The large colon creates a large amount of suction behind a foreign body due to the normal collapse of the bowel. If you ask 4 docs how to remove a rectal foreign body, you will get 6 different answers. There are a lot of "tricks of the trade" for removal, but they usually don't work. Have any tricks work for you?

You can try to....

1. Break the suction by advancing a foley past the object and inflating the balloon.

2. McRobert's maneuver as you are literally attempting to deliver an object.

3. Lidocaine jelly and use a speculum.





The issue with all the removal techniques is that they need marked sedation and probably complete paralysis in the OR and all come with a risk of rupture, so having your surgical colleagues involved early may be helpful, especially if there is any signs of peritonitis or perforation.

Rectal foreign bodies are of the utmost interest to the general public.Every time someone finds out that I'm an ER doc the questions about rectal foreign bodies are mentioned, usually within the first 5 minutes: "Did you ever see one? What was it? What was the story?"I wouldn't mind if people asked about heart attacks, car accidents, life saving procedures, or what my day to day is like, but it invariably turns to rectal foreign bodies. What is the fascination of the questioning, not receiving.Have you ever wondered why there are some many x-rays of rectal foreign bodies? Besides the good giggle, there is actually good reasoning.1) Perforation. You (and I) both know that the rectal foreign body didn't get placed just prior to arrival. It was probably in there for hours with numerous (failed) attempts at home removal and probably pushing it in farther.The time table is usually something like this:Hour 1: disbelief /pacingHour 2: anger /self attempt at removalHour 3: embarrassment /find a friend that can keep a secretHour 4: giving up /go to ER2) Self protection. People put a lot of odd shaped things in their rectum, not to mention sharp objects and dangerous objects, especially if they are trying to sneak them into jail. An x-ray is a very good idea PRIOR to the rectal exam to make sure you don't hurt yourself or cause more harm.