Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature.
Emergency
Foreign body
Management
Rectum
Sepsis
Surgery
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
10
01
2022
accepted:
24
05
2022
pubmed:
3
6
2022
medline:
15
9
2022
entrez:
2
6
2022
Statut:
ppublish
Résumé
Retained rectal foreign bodies (RFBs) are uncommon clinical findings. Although the management of RFBs is rarely reported in the literature, clinicians regularly face this issue. To date, there is no standardized management of RFBs. The aim of the present study was to evaluate our own data and subsequently develop a treatment algorithm. All consecutive patients who presented between January 2006 and December 2019 with rectally inserted RFBs at the emergency department of the Klinikum Stuttgart, Germany, were retrospectively identified. Clinicopathologic features, management, complications, and outcomes were assessed. Based on this experience, a treatment algorithm was developed. A total of 69 presentations with rectally inserted RFBs were documented in 57 patients. In 23/69 cases (33.3%), the RFB was removed transanally by the emergency physician either digitally (n = 14) or with the help of a rigid rectoscope (n = 8) or a colonoscope (n = 1). In 46/69 cases (66.7%), the RFB was removed in the operation theater under general anesthesia with muscle relaxation. Among these, 11/46 patients (23.9%) underwent abdominal surgery, either for manual extraction of the RFB (n = 9) or to exclude a bowel perforation (n = 2). Surgical complications occurred in 3/11 patients. One patient with rectal perforation developed pelvic sepsis and underwent abdominoperineal extirpation in the further clinical course. The management of RFBs can be challenging and includes a wide range of options from removal without further intervention to abdominoperineal extirpation in cases of pelvic sepsis. Whenever possible, RFBs should obligatorily be managed in specialized colorectal centers following a clear treatment algorithm.
Sections du résumé
BACKGROUND
BACKGROUND
Retained rectal foreign bodies (RFBs) are uncommon clinical findings. Although the management of RFBs is rarely reported in the literature, clinicians regularly face this issue. To date, there is no standardized management of RFBs. The aim of the present study was to evaluate our own data and subsequently develop a treatment algorithm.
METHODS
METHODS
All consecutive patients who presented between January 2006 and December 2019 with rectally inserted RFBs at the emergency department of the Klinikum Stuttgart, Germany, were retrospectively identified. Clinicopathologic features, management, complications, and outcomes were assessed. Based on this experience, a treatment algorithm was developed.
RESULTS
RESULTS
A total of 69 presentations with rectally inserted RFBs were documented in 57 patients. In 23/69 cases (33.3%), the RFB was removed transanally by the emergency physician either digitally (n = 14) or with the help of a rigid rectoscope (n = 8) or a colonoscope (n = 1). In 46/69 cases (66.7%), the RFB was removed in the operation theater under general anesthesia with muscle relaxation. Among these, 11/46 patients (23.9%) underwent abdominal surgery, either for manual extraction of the RFB (n = 9) or to exclude a bowel perforation (n = 2). Surgical complications occurred in 3/11 patients. One patient with rectal perforation developed pelvic sepsis and underwent abdominoperineal extirpation in the further clinical course.
CONCLUSION
CONCLUSIONS
The management of RFBs can be challenging and includes a wide range of options from removal without further intervention to abdominoperineal extirpation in cases of pelvic sepsis. Whenever possible, RFBs should obligatorily be managed in specialized colorectal centers following a clear treatment algorithm.
Identifiants
pubmed: 35654873
doi: 10.1007/s00423-022-02571-z
pii: 10.1007/s00423-022-02571-z
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2499-2508Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Shaban Y, Elkbuli A, Ovakimyan V et al (2019) Rectal foreign body causing perforation: case report and literature review. Ann Med Surg (Lond) 47:66–69
doi: 10.1016/j.amsu.2019.10.005
Kurer MA, Davey C, Khan S et al (2010) Colorectal foreign bodies: a systematic review. Colorectal Dis 12(9):851–861
doi: 10.1111/j.1463-1318.2009.02109.x
Kim JH, Um E, Jung SM et al (2020) The management of retained rectal foreign body. Ann Coloproctol 36(5):335–343
doi: 10.3393/ac.2019.10.03.1
Kokemohr P, Haeder L, Fromling FJ et al (2017) Surgical management of rectal foreign bodies: a 10-year single-center experience. Innov Surg Sci 2(2):89–95
pubmed: 31579741
pmcid: 6754005
Ayantunde AA, Unluer Z (2016) Increasing trend in retained rectal foreign bodies. World J Gastrointest Surg 8(10):679–684
doi: 10.4240/wjgs.v8.i10.679
Schellenberg M, Brown CVR, Trust MD et al (2020) Rectal injury after foreign body insertion: secondary analysis from the AAST contemporary management of rectal injuries study group. J Surg Res 247:541–546
doi: 10.1016/j.jss.2019.09.048
Goldberg JE, Steele SR (2010) Rectal foreign bodies. Surg Clin North Am 90(1):173–84 (Table of Contents)
doi: 10.1016/j.suc.2009.10.004
Huang WC, Jiang JK, Wang HS et al (2003) Retained rectal foreign bodies. J Chin Med Assoc 66(10):607–612
pubmed: 14703278
Lake JP, Essani R, Petrone P et al (2004) Management of retained colorectal foreign bodies: predictors of operative intervention. Dis Colon Rectum 47(10):1694–1698
doi: 10.1007/s10350-004-0676-4
Polackwich AS, Shoskes DA (2016) Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis 19(2):132–138
doi: 10.1038/pcan.2016.8
Bharucha AE, Lee TH (2016) Anorectal and pelvic pain. Mayo Clin Proc 91(10):1471–1486
doi: 10.1016/j.mayocp.2016.08.011
Masterson TA, Masterson JM, Azzinaro J et al (2017) Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Transl Androl Urol 6(5):910–915
doi: 10.21037/tau.2017.08.17
Shao F, Shen N, Hong Z et al (2020) Injuries due to foreign body ingestion and insertion in children: 10 years of experience at a single institution. J Paediatr Child Health 56(4):537–541
doi: 10.1111/jpc.14677
Mahapatra RS, Priyadarshi V, Madduri VK, et al. 2014 Transrectal impalement of an incense stick in a child presenting as foreign body in the urinary bladder. BMJ Case Rep 2014.
Fischer J, Krishnamurthy J, Hansen S, et al. (2019) Austere foreign body injuries in children and adolescents: a characterization of penile, rectal, and vaginal injuries presenting to emergency departments in the United States from 2008 to 2017. Pediatr Emerg Care
Yildiz SY, Kendirci M, Akbulut S et al (2013) Colorectal emergencies associated with penetrating or retained foreign bodies. World J Emerg Surg 8(1):25
doi: 10.1186/1749-7922-8-25
Ye H, Huang S, Zhou Q et al (2018) Migration of a foreign body to the rectum: a case report and literature review. Medicine (Baltimore) 97(28):e11512
doi: 10.1097/MD.0000000000011512
Anderson KL, Dean AJ (2011) Foreign bodies in the gastrointestinal tract and anorectal emergencies. Emerg Med Clin North Am 29(2):369–400
doi: 10.1016/j.emc.2011.01.009
Ikram S, Singh S, Kallam R, et al. (2017) A play that went wrong: unique presentation of bowel perforation from an unusually large per-rectal foreign body. BMJ Case Rep 2017.
Coskun A, Erkan N, Yakan S et al (2013) Management of rectal foreign bodies. World J Emerg Surg 8(1):11
doi: 10.1186/1749-7922-8-11
Arvieux C, Thony F, Broux C et al (2012) Current management of severe pelvic and perineal trauma. J Visc Surg 149(4):e227–e238
doi: 10.1016/j.jviscsurg.2012.06.004
Hornez E, Monchal T, Boddaert G et al (2016) Penetrating pelvic trauma: initial assessment and surgical management in emergency. J Visc Surg 153(4 Suppl):79–90
doi: 10.1016/j.jviscsurg.2016.04.006
Ahern DP, Kelly ME, Courtney D et al (2017) The management of penetrating rectal and anal trauma: a systematic review. Injury 48(6):1133–1138
doi: 10.1016/j.injury.2017.03.002
Clemens MS, Peace KM, Yi F (2018) Rectal trauma: evidence-based practices. Clin Colon Rectal Surg 31(1):17–23
doi: 10.1055/s-0037-1602182
Cologne KG, Ault GT (2012) Rectal foreign bodies: what is the current standard? Clin Colon Rectal Surg 25(4):214–218
doi: 10.1055/s-0032-1329392
Fleres F, Ieni A, Saladino E et al (2018) Rectal perforation by inadvertent ingestion of a blister pack: a case report and review of literature. World J Clin Cases 6(10):384–392
doi: 10.12998/wjcc.v6.i10.384