Makindo Medical Notes

🚑 A rectal foreign body (RFB) is any object inserted into the rectum, either intentionally or accidentally, that cannot be naturally expelled. These cases may present as emergencies due to pain, obstruction, or perforation risk, and often require procedural sedation for safe removal in the Emergency Department (ED).

🔎 Definition

• An object lodged in the rectum that cannot be expelled spontaneously.
• May cause pain, obstruction, bleeding, or perforation.
• Often requires procedural sedation and careful extraction techniques.

⚡ Causes

• 🔞 Sexual gratification (e.g., vibrators, dildos, bottles)
• 🚨 Accidental insertion (e.g., falls onto objects)
• 💊 Self-treatment of constipation (e.g., homemade enemas, vegetables)
• 🧠 Psychiatric conditions or substance abuse
• 🛂 Criminal activity → body packing in drug trafficking

🩺 Clinical Presentation

• Abdominal or rectal pain
• 🚫 Inability to pass stool or flatus (bowel obstruction)
• 💉 Rectal bleeding
• Palpable object on digital rectal examination (DRE)
• ⚠️ Sometimes denied in history → high suspicion needed

🔬 Investigations

• Clinical Examination:
  • Abdominal exam → tenderness, guarding, distension
  • DRE → palpate object, assess sphincter tone
• Imaging:
  • 📸 Abdominal X-ray → radiopaque objects, free air
  • 🖥️ CT scan → radiolucent objects, perforation, obstruction
• Blood Tests:
  • FBC → infection, bleeding
  • CRP → inflammation
  • U&E → hydration, obstruction

💊 Management

• Initial Assessment:
  • 🔄 ABC stabilisation (Airway, Breathing, Circulation)
  • 💉 Analgesia & IV access
• Removal Techniques:
  • Manual extraction in ED → forceps + patient bearing down
  • Break vacuum seal with Foley catheter balloon if impacted
  • Procedural sedation or regional anaesthesia often required
  • Appropriate position → lithotomy or lateral decubitus
  • Endoscopic retrieval if unsuccessful
  • 🚨 Surgical intervention → if sharp, large, high, or perforated
• Post-Removal Care:
  • Check for mucosal tears, perforation (endoscopy if needed)
  • Start antibiotics if perforation/sepsis suspected
  • Consider psychiatric/psychosexual referral if recurrent

⚠️ Complications

• Perforation & peritonitis
• Bowel obstruction
• Abscess or sepsis
• Rectal bleeding
• Chronic sphincter dysfunction → incontinence

🛡️ Prevention

• Use sex toys with flared bases to prevent migration
• Address underlying psychiatric illness
• Substance misuse support
• Education on safer practices