Surgical management of rectal foreign bodies: A single-center experience

BACKGROUND: Rectal foreign bodies (RFBs) are one of the rare clinical presentations in colorectal surgical practice, with an increasing incidence over the recent years. Due to the lack of standardized treatment options, the management of RFBs can be challenging. This study aimed to evaluate our diagnostic and therapeutic approach to RFBs and to suggest a management algorithm. METHODS: All patients with RFBs who hospitalized between January 2010 and December 2020 were retrospectively reviewed. Patient demographics, RFB insertion mechanism, inserted objects, diagnostic findings, management, complications, and outcomes were all evaluated. An algorithm for clinical management was developed depending on the center’s experience. RESULTS: The cohort consisted of 21 patients, 17 (81%) were males. The median age was 33 years (ranging, 19–71). Sexual preferences were the reason for RFB in 15 (71.4%) patients. In 17 (81%) patients, the RFB size over 10 cm. In 4 (19%) patients, RFBs were removed transanally without anesthesia in the emergency department; in the remaining 17 (81%), they were removed under anesthesia. Among these, RFBs were removed transanally under general anesthesia in 2 (9.5%) patients; with the assistance of a colonoscope under anesthesia in 8 (38%) patients; by milking towards the transanal route during laparotomy in 3 (14.2%) patients; and with the Hartmann procedure without restoration of bowel continuity in 4 (19%) patients. The median hospital stay was 6 days (ranging, 1–34 days). The Clavien-Dindo grade III-IV complication rate was 9.5%, and no post-operative mortality was observed. CONCLUSION: RFBs can usually be successfully removed transanally in the operating room with appropriate anesthetic technique and proper surgical instrument selection.