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Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature

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Abstract

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

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

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

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.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the members of the Department of Emergency, Klinikum Stuttgart, for their contribution to the study. Moreover, the authors thank Sandra Cseledes for data collection and Angelika Hildebrandt for English language editing.

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Author notes

  1. Stefan Fritz and Hansjörg Killguss contributed equally.

Authors and Affiliations

  1. Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany

    Stefan Fritz, Hansjörg Killguss, André Schaudt & Jörg Köninger

  2. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Stefan Fritz & Christoph Reissfelder

  3. Deutsches End- und Dickdarmzentrum, Mannheim, Germany

    Stefan Fritz

  4. Department of Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany

    Christof M. Sommer & Götz M. Richter

  5. Department of Medicine II, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Sebastian Belle

  6. Department of Pediatric Surgery, Klinikum Stuttgart, Stuttgart, Germany

    Steffan Loff

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  1. Stefan Fritz
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Contributions

SF, HK, and CMS were responsible for data collection. SF, HK, and JK analyzed and interpreted the patient data. SF, HK, JK, and CMS were major contributors in writing the manuscript. AS, GMR, SB, CR, and SL contributed significantly by proofreading the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stefan Fritz.

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Ethics approval and consent to participate

The study was designed as an observational retrospective analysis. The study did not influence the therapy in any way.

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The present manuscript does not contain any individual person’s data in any form.

Conflict of interest

The authors declare no competing interests.

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Fritz, S., Killguss, H., Schaudt, A. et al. Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature. Langenbecks Arch Surg 407, 2499–2508 (2022). https://doi.org/10.1007/s00423-022-02571-z

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  • DOI: https://doi.org/10.1007/s00423-022-02571-z

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