Any object introduced into the rectum is called a rectal foreign body. The severity of this situation varies from pain only during defecation to sepsis with multiorgan failure. The process of extracting a rectal foreign body is explained below.The rectal foreign bodies normally lodge in the transition from the anus to the rectum. In an area where the mucosa changes histologically and is narrowed due to the presence of several muscles that contract spasmodically.The most usual is that they are food remains swallowed, but could not be digested. Within this group we find chicken bones, fish bones, seeds, etc. However, they can also be forgotten objects after a surgical intervention or erotic toys.
How is the clinic of a rectal foreign body?
The most frequent sign is pain in the anal region. It is an intense pain that is not related to defecation. Although it is possible to get worse during this process due to increased pressure.In some cases perforation of the rectal mucosa may occur, if this is the case, the patient would present continuous bleeding. This clinical sign is called rectorrhagia and is a risk factor when it comes to contracting an infection by the bacteria that make up the rectal flora. In addition, it can be accompanied by tears that would cause fistulas or anal fissures.The complication of worse prognosis is the irritation of the peritoneum. These cases are usually accompanied by sepsis. That is, we would speak of a disseminated infection that can trigger a multi-organ response with shock from the patient.A complete clinical history is usually sufficient to describe the object housed. In addition, it is important to ask the patient if they have noticed abdominal discomfort or difficulty defecating. The stopping of the intestinal transit produces proliferation of the bacteria present in the fecal matter. In these cases, the patient has fever and signs of inflammation.
How are rectal foreign bodies located?
The first thing to do to locate the object is an exploration using imaging techniques. In these patients it is contraindicated to perform a digital rectal examination since it would help to introduce more the foreign body. The most common is to perform an X-ray since most foreign bodies are visible through the use of X-rays. The best projection to visualize the object is a posterior plane where the pelvis is seen completely.You always have to perform an imaging technique to rule out the perforation of the rectum. Once this complication is ruled out, it is planned which action is the most advisable according to the characteristics of the object (size, shape and location).In the case that the object is palpable, it is directly extracted by anal dilators. The area is anesthetized by the application of anesthetic ointments or injection of local anesthetic. And then a rectum separator is introduced that allows access to the foreign body.If the x-ray reveals that the object is in a deep plane it is necessary to perform surgery. These surgical interventions are high risk given the area involved. It is a region plagued by bacteria and is also a very innervated area. Any injury to a nerve can cause incontinence that negatively affects the quality of life of the patient.Taking into account these complications, it is decided to accelerate the peristalsis of the patient to favor the dragging of the foreign body. In the event that it fails, a sigmoidoscope can be used. And as a last resort, surgery would be done using laparoscopic techniques. (less invasive, reducing the risk of complications) or colotomy when another option is not possible.
What measures to take after the extraction?
After the extraction it is necessary to perform a sigmoidoscopy to assess the state of the rectal mucosa after extraction and rule out the risk of perforation. In addition, it serves to rule out that the object has been fragmented and remains of it.Once the results of the imaging test rule out the presence of a foreign body and rectal perforation. Extreme hygiene is necessary until the mucosa regenerates completely.