View source for Rectal foreign body

{{Short description|Large bodies found in the rectum in medical context}}
{{Use mdy dates|date = February 2019}}
{{Use American English|date = February 2019}}
{{Infobox medical condition
| name            = Rectal foreign body
| synonyms        = 
| image           = CAVibrator.jpg
| alt             = 
| caption         = Radiograph of a male abdomen with a vibrator inside the rectum
| pronounce       = 
| field           = [[Emergency medicine]], [[general surgery]]
| symptoms        = 
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| causes          = 
| risks           = 
| diagnosis       = 
| differential    = 
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}}

'''Rectal foreign bodies''' are large [[Foreign body|foreign items]] found in the [[rectum]] that can be assumed to have been inserted through the anus, rather than reaching the rectum via the mouth and gastrointestinal tract. It can be of clinical relevance if the patient cannot remove it the way they intended. Smaller, ingested foreign bodies, such as bones eaten with food, can sometimes be found stuck in the rectum upon X-ray and are rarely of clinical relevance.

Rectal foreign bodies are a subgroup of [[Foreign body in alimentary tract|foreign bodies in the alimentary tract]].<ref>{{cite journal | vauthors = Ayantunde AA, Oke T | title = A review of gastrointestinal foreign bodies | journal = International Journal of Clinical Practice | volume = 60 | issue = 6 | pages = 735–9 | date = June 2006 | pmid = 16805760 | doi = 10.1111/j.1368-5031.2006.00709.x | s2cid = 33704778 }}</ref><ref name="PMID17556153">{{cite journal | vauthors = Smith MT, Wong RK | title = Foreign bodies | journal = Gastrointestinal Endoscopy Clinics of North America | volume = 17 | issue = 2 | pages = 361–82, vii | date = April 2007 | pmid = 17556153 | doi = 10.1016/j.giec.2007.03.002 }}</ref>

== Signs and symptoms ==
If the foreign body is too big to allow feces from the colon to pass, a mechanical [[ileus]] may occur. The distension of the rectum and the disruption of the [[Vasoconstriction|peristasis]] reinforce this effect.

The foreign body may cause infections, destroying the intestinal wall. Depending on the location of the perforation, this may lead to a [[peritonitis]] due to the feces or an [[abscess]] in the retroperitoneal space.

Smaller objects that injure the intestinal wall, but do not perforate it, may be encapsulated by a [[foreign body granuloma]]. They may remain in the rectum as a [[pseudotumor]] without any further effects.

=== Complications ===
The most common – but still rare – [[complication (medicine)|complication]] is a perforation of the rectum caused by the foreign object itself or attempts to remove it. Diagnosed perforations are operated immediately by opening the [[abdomen]] and removal or [[surgical suturing|suturing]] of the perforated area. In order to suppress [[infections]], antibiotics are prescribed.<ref name="PMID984928" /> Often, a temporary [[ileostomy]] is necessary to protect the stitches.<ref name="PMID8908954" /> After a contrast medium applied by an enema proves the complete healing of the perforated area, the ileostomy is reversed. This usually takes between three and six months.<ref name="pmid11767487">{{cite journal | vauthors = Ruiz del Castillo J, Sellés Dechent R, Millán Scheiding M, Zumárraga Navas P, Asencio Arana F | title = Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management | journal = Revista Española de Enfermedades Digestivas | volume = 93 | issue = 10 | pages = 631–4 | date = October 2001 | pmid = 11767487 }}</ref> Average hospitalization is 19 days.<ref name="PMID984928" />

Medical literature describes some deaths due to rectal foreign bodies, but they are very rare and usually classified as [[autoerotic fatality]]. A 75-year-old patient died due to a rectal perforation caused by a [[Mental disorder|mentally ill]] person using a cane.<ref>{{cite journal | vauthors = Ikeda N, Hulewicz B, Knight B, Suzuki T | title = Homicide by rectal insertion of a walking stick | journal = Nihon Hoigaku Zasshi = The Japanese Journal of Legal Medicine | volume = 45 | issue = 4 | pages = 341–4 | date = August 1991 | pmid = 1766149 }}</ref> Another middle-aged patient died due to a rectal perforation by a vibrator. The perforation was sutured and the patient received intensive medical care, but he contracted [[acute respiratory distress syndrome]] and [[systemic inflammatory response syndrome]] due to the trauma, resulting in [[multiple organ dysfunction syndrome]] and death.<ref>{{cite journal | vauthors = Waraich NG, Hudson JS, Iftikhar SY | title = Vibrator-induced fatal rectal perforation | journal = The New Zealand Medical Journal | volume = 120 | issue = 1260 | pages = U2685 | date = August 2007 | pmid = 17726499 }}</ref> There is a paper describing a death after a perforation with a [[shoehorn]].<ref name="pmid10739230">{{cite journal | vauthors = Byard RW, Eitzen DA, James R | title = Unusual fatal mechanisms in nonasphyxial autoerotic death | journal = The American Journal of Forensic Medicine and Pathology | volume = 21 | issue = 1 | pages = 65–8 | date = March 2000 | pmid = 10739230 | doi = 10.1097/00000433-200003000-00012 }}</ref> The rectum has to be nursed after a surgical procedure until healing is complete. A 54-year-old man, who had been operated on twice in order to remove a foreign body (a cucumber and a parsnip), died due to a [[peritonitis]] after he inserted two apples into the rectum before the wound had healed.<ref name="Spiegel1991" />

== Causes ==
Reasons for foreign rectal bodies vary wildly, but in most cases they are of sexual or criminal motivation.<ref name="Messmann2004">{{cite book | vauthors = Messmann H | title = Lehratlas der Koloskopie. | publisher = Georg Thieme Verlag | date = 2004 | isbn = 3-13-136441-6 | pages = 219 }} {{Google books|TCeklf42u0wC||page=219}}</ref> The foreign body was inserted voluntarily in the vast majority of cases. This especially includes sexually motivated behaviour, encompassing the majority of cases. [[Bodypacking]], i.e. illegal transport of [[drugs]] within a body orifice (here: inside the rectum), is another – potentially – voluntary reason for insertion of foreign rectal bodies.<ref>{{cite thesis | vauthors = Laitenberger MC | degree = Ph.D. | url = http://d-nb.info/978949625/34 | title = Klinische und rechtsmedizinische Aspekte des intestinalen Rauschmitteltransportes in Hamburg 1989 bis 2004 | publisher = Universität Hamburg | date = 2005 }}</ref> This includes attempts to transport objects like weapons, including knives, or ammunition. According to one study, sexual stimulation was responsible for 80% of clinically relevant foreign rectal bodies. About 10% of the cases were due to sexual assault.<ref name="PMID8908954">{{cite journal | vauthors = Cohen JS, Sackier JM | title = Management of colorectal foreign bodies | journal = Journal of the Royal College of Surgeons of Edinburgh | volume = 41 | issue = 5 | pages = 312–5 | date = October 1996 | pmid = 8908954 }}</ref>

In rare cases, the patient inserted the object into the rectum without a way to remove it intending to receive attention and pity from doctors and nurses. This behaviour is categorized as [[Munchausen's syndrome]].<ref name="PMID18925957">{{cite journal | vauthors = Khan SA, Davey CA, Khan SA, Trigwell PJ, Chintapatla S | title = Munchausen's syndrome presenting as rectal foreign body insertion: a case report | journal = Cases Journal | volume = 1 | issue = 1 | article-number = 243 | date = October 2008 | pmid = 18925957 | pmc = 2572607 | doi = 10.1186/1757-1626-1-243 | doi-access = free }}</ref>

Another cause may be attempted self-treatment of diseases. One patient attempted to treat his chronic [[diarrhea]] by inserting an ear of [[maize]] into his rectum.<ref>{{cite journal | vauthors = Stenz V, Thurnheer R, Widmer F, Krause M | title = [Foreign body stories] | journal = Therapeutische Umschau. Revue Therapeutique | volume = 65 | issue = 12 | pages = 699–702 | date = December 2008 | pmid = 19048523 | doi = 10.1024/0040-5930.65.12.699 }}</ref> Another patient tried to soothe the itching due to his [[hemorrhoids]] (''[[Pruritus ani]]'') with a [[toothbrush]]. The toothbrush went out of control and disappeared inside his anus.<ref name="PMID11491473">{{cite journal | vauthors = Kumar M | title = Don't forget your toothbrush! | journal = British Dental Journal | volume = 191 | issue = 1 | pages = 27–8 | date = July 2001 | pmid = 11491473 | doi = 10.1038/sj.bdj.4801082a | url = http://www.nature.com/bdj/journal/v191/n1/full/4801082a.html | url-access = subscription }}</ref>

Accidents or [[torture]] may cause an involuntary insertion of a foreign body.<ref>{{cite report | vauthors = Nuschler F | url = http://inef.uni-due.de/cms/files/report01.pdf | title = Bericht über die internationale Folterfoschung | publisher = Universität Duisburg | date = 1992 | archive-url = https://web.archive.org/web/20110719103018/http://inef.uni-due.de/cms/files/report01.pdf | archive-date = July 19, 2011 }}</ref> A mercury [[medical thermometer]] inserted into the anus in order to measure the temperature, but broke off while inside, is an example of a foreign rectal body due to an accident.<ref name="PMID19444034">{{cite journal | vauthors = Azman B, Erkuş B, Güvenç BH | title = Balloon extraction of a retained rectal foreign body under fluoroscopy, case report and review | journal = Pediatric Emergency Care | volume = 25 | issue = 5 | pages = 345–7 | date = May 2009 | pmid = 19444034 | doi = 10.1097/PEC.0b013e3181a3494f | s2cid = 13623925 }}</ref> Ancient Greece knew the [[Rhaphanidosis]] as a punishment for male adulterers. It involved the insertion of a [[radish]] into the anus. Many self-inserted rectal bodies are stated as accidentally by the patients due to feelings of shame.

There are several reasons that contribute to the jamming of rectal bodies inside the rectum. Many of the objects used for sexual stimulation have a conical tip in order to facilitate penetration, while the base is flat. Extraction by the user may be impossible if the base of the object passed the anus towards the rectum. In order to receive a stronger stimulation, the object may be inserted deeper than intended. In this case, the [[sphincter]] prevents, by mechanical means, the extraction of the foreign body.<ref name="PMID984928" />

=== By mouth ===
The other way for a foreign body to travel through the digestive system (after oral intake and passage through the entire intestines) happens very often, but is only rarely medically relevant. Other constrictions, such as the [[esophagus]], [[cardia]], [[pylorus]] or [[ileocecal valve]] tend to cause issues with other organs, provided a foreign body is large enough to be an issue. Some foreign bodies may still pass those narrows and may cause medically relevant issues, i.e. toothpicks and bones.<ref name="PMID17556153" /><ref name="Munter2009" /><ref name="PMID1854398">{{cite journal | vauthors = Davies DH | title = A chicken bone in the rectum | journal = Archives of Emergency Medicine | volume = 8 | issue = 1 | pages = 62–4 | date = March 1991 | pmid = 1854398 | doi = 10.1136/emj.8.1.62 | pmc = 1285738 }}</ref> Bones especially, i.e. from chickens, cause about two thirds of all intestinal perforations.<ref name="PMID1854398"/><ref>{{cite journal | vauthors = McManous JE | title = Perforation of the intestine by ingested foreign body. | journal = American Journal of Surgery | date = 1941 | volume = 53 | pages = 393–402 | doi = 10.1016/S0002-9610(41)90652-9 }}</ref>

Plant-based food, especially [[seeds]] like [[popcorn]],<ref>{{cite journal | vauthors = Roberge RJ, Squyres NS, MacMath TL | title = Popcorn primary colonic phytobezoar | journal = Annals of Emergency Medicine | volume = 17 | issue = 1 | pages = 77–9 | date = January 1988 | pmid = 3337421 | doi = 10.1016/s0196-0644(88)80510-9 }}</ref> [[watermelon]], [[sunflower seed|sunflower]] and [[pumpkin]] seed, may clump together inside the lower intestines to form [[bezoar]]s. Those may grow too big for normal anal passage, thus becoming clinically relevant. This kind of rectal foreign body happens chiefly in children, especially in [[Northern Africa]] and the [[Middle East]], where those seeds form an elemental part of the diet.<ref>{{cite journal | vauthors = Eitan A, Katz IM, Sweed Y, Bickel A | title = Fecal impaction in children: report of 53 cases of rectal seed bezoars | journal = Journal of Pediatric Surgery | volume = 42 | issue = 6 | pages = 1114–7 | date = June 2007 | pmid = 17560231 | doi = 10.1016/j.jpedsurg.2007.01.048 }}</ref><ref name="pmid19211433">{{cite journal | vauthors = Mirza MS, Al-Wahibi K, Baloch S, Al-Qadhi H | title = Rectal bezoars due to pumpkin seeds | journal = Tropical Doctor | volume = 39 | issue = 1 | pages = 54–5 | date = January 2009 | pmid = 19211433 | doi = 10.1258/td.2008.080107 | s2cid = 32157500 }}</ref> In very rare cases, seeds inside a bezoar may germinate inside the lower intestines or the rectum, causing a blockade.<ref name="pmid19762589">{{cite journal | vauthors = Mahjoub F, Kalantari M, Tabarzan N, Moradi B | title = Invading plant material appearing as a colonic tumoural mass in a four-year-old girl | journal = Tropical Doctor | volume = 39 | issue = 4 | pages = 253–4 | date = October 2009 | pmid = 19762589 | doi = 10.1258/td.2009.090052 | s2cid = 21877151 }}</ref>

=== Objects ===
Type and size of the foreign rectal bodies are diverse and may exceed the anatomical-physiological imagination.<ref name="Messmann2004" />

Objects documented in literature include:
* Razor, screw, screwdriver, small rolled tool bag (15×12&nbsp;cm, including tools 620&nbsp;g), [[hairpin]], milk can opener, drill bit
* Short staffs, such as a 27&nbsp;cm long chair leg, a 19&nbsp;cm long [[spade]] handle and a broken off broom handle, extension parts for a vacuum cleaner
* Containers, sometimes exceeding 0.5&nbsp;L in volume, e.g. sparkling wine bottles, bottles of Coca-Cola, jam pots, small beer glasses, cups
* Spray can, light bulb, [[vacuum tube]], candle
* WWII artillery shell requiring attention from a bomb squad<ref>{{cite web |url=https://news.yahoo.com/bomb-squad-called-er-patient-100800683.html |title=Bomb squad called to ER after a patient turned up with a WWII artillery shell lodged in his rectum, police say |work=[[Yahoo! News]] |author=Joshua Zitser |date=December 4, 2021 |access-date=December 4, 2021}}</ref>
* [[Table tennis]] ball, [[Boccia]] ball
* [[Ammunition]], [[firecracker]]
* [[Vibrator (sex toy)|Vibrator]], rubber rod, [[dildo]]
* [[Jackass: The Movie|a toy car]]
* [[spectacles]], a suitcase key, a tobacco pouch and a magazine at the same time
* plastic tooth brush case<ref name="Messmann2004" /><ref name="PMID984928">{{cite journal | vauthors = Barone JE, Sohn N, Nealon TF | title = Perforations and foreign bodies of the rectum: report of 28 cases | journal = Annals of Surgery | volume = 184 | issue = 5 | pages = 601–4 | date = November 1976 | pmid = 984928 | doi = 10.1097/00000658-197611000-00011 | pmc = 1345490 }}</ref><ref name="Spiegel1991">{{citation  |title=Sturz in die Kiste   |url=http://www.spiegel.de/spiegel/print/d-13491232.html  |work=[[Der Spiegel]]  |year=1991  |issue=41  |series=7 October 1991  |pages=317–320  }}</ref><ref name="PMID3738771"/><ref>{{cite journal | vauthors = Akhtar MA, Arora PK | title = Case of unusual foreign body in the rectum | journal = Saudi Journal of Gastroenterology | volume = 15 | issue = 2 | pages = 131–2 | date = April 2009 | pmid = 19568580 | pmc = 2702971 | doi = 10.4103/1319-3767.48973 | doi-access = free }}</ref><ref name="PMID18925957"/>

Not all objects are solid. In 1987, a case was documented of a patient who administered a [[cement]] [[enema]]. After it solidified and impacted, the resulting block had to be surgically extracted.<ref>{{cite journal | vauthors = Stephens PJ, Taff ML | title = Rectal impaction following enema with concrete mix | journal = The American Journal of Forensic Medicine and Pathology | volume = 8 | issue = 2 | pages = 179–82 | date = June 1987 | pmid = 3649167 | doi = 10.1097/00000433-198708020-00019 }}</ref> Another extreme case occurred in November 1953. A depressed man inserted a 15&nbsp;cm long cardboard tube into his rectum and tossed a lighted firecracker into the tube's opening, resulting in a large hole in his rectum.<ref>{{cite journal | vauthors = Butters AG | title = An unusual rectal injury | journal = British Medical Journal | volume = 2 | issue = 4939 | pages = 602–3 | date = September 1955 | pmid = 13240191 | doi = 10.1136/bmj.2.4939.602 | pmc = 1980742 }}</ref>

== Diagnosis ==
Many patients feel ashamed during the [[Medical history|anamnesis]] and provide information only reluctantly. This may lead to missing information that may be important during therapy. For the same reason, patients may not visit a doctor until very late. Trusting and sensitive care for the ashamed and uncomfortable patients is paramount for a successful therapy<ref name="PMID9887927">{{cite journal | vauthors = Mackinnon RP | title = Removing rectal foreign bodies: is the ventouse gender specific? | journal = The Medical Journal of Australia | year = 1998 | volume = 169 | issue = 11–12 | pages = 670–1 | doi = 10.5694/j.1326-5377.1998.tb123462.x | pmid = 9887927 | s2cid = 41156541 }}</ref> and may be life-saving.<ref>{{cite book | vauthors = Stein E | title = Proktologie: Lehrbuch und Atlas. | publisher = Verlag Springer | date = 2002 | isbn = 3-540-43033-4 | pages = 329 }} {{Google books|8yQAecJo5AoC||page=329}}</ref>

Usually, several [[radiology|radiological]] images are recorded in order to pinpoint the precise place and depth of the foreign body. This is usually done by [[X-ray]]. Foreign bodies made from low-contrast material (e.g. plastics) may necessitate [[medical ultrasound]] or a [[CT scan]].<ref name="PMID9887927" /> [[Magnetic resonance imaging]] is [[contraindication|contraindicated]], especially if the foreign body is unknown. Foreign rectal bodies may penetrate deep into the colon, in certain circumstances up to the [[right colic flexure]].<ref name="Messmann2004" />

An [[endoscopy]], which may also be of use during therapy, facilitates the identification and localisation of the object inside the rectum.<ref name="Axon2004">{{cite book | vauthors = Axon AT, Classen M | title = Gastroenterologische Endoskopie. | publisher = Georg Thieme Verlag | date = 2004 | isbn = 3-13-132401-5 | pages = 400–401}} {{Google books|6LtyFKwyCv4C||page=400}}</ref>

Information about the foreign body obtained in those ways are of high importance during therapy, as a [[perforation]] of the rectum or the anus is to be absolutely avoided.

== Treatment ==
[[File:Rectal foreign body 02.jpg|thumb|Endoscopic sling with the fragment of a glass bottle.]]
The therapeutic measures to remove the foreign body can be as diverse as the objects inside the rectum. In many instances, the foreign bodies consist of fragile materials, such as glass. Most patients wait for several hours or even days until they visit a doctor. Before they do, they often repeatedly try to remove the object themselves or by a layperson. This often worsens the situation for a successful extraction.

In most cases, the foreign body can be removed endoscopically. Vibrators, for example, can be often removed using a large sling usually used to remove [[polyp (medicine)|polyps]] during [[coloscopy]].<ref name="PMID14703278">{{cite journal | vauthors = Huang WC, Jiang JK, Wang HS, Yang SH, Chen WS, Lin TC, Lin JK | title = Retained rectal foreign bodies | journal = Journal of the Chinese Medical Association | volume = 66 | issue = 10 | pages = 607–12 | date = October 2003 | pmid = 14703278 }}</ref> A flexible endoscope can be of no help with large and jammed objects. It may be preferable to use rigid tools in those cases.<ref name="Messmann2004" />

There have been several cases where instruments used in child birth have proven their worth for the removal of those foreign bodies, such as the [[forceps]]<ref name="PMID1252815">{{cite journal | vauthors = Peet TN | title = Removal of impacted rectal foreign body with obstetric forceps | journal = British Medical Journal | volume = 1 | issue = 6008 | pages = 500–1 | date = February 1976 | pmid = 1252815 | pmc = 1638849 | doi = 10.1136/bmj.1.6008.500 }}</ref> and [[ventouse|suction cups]].<ref name="PMID8756851" />
Wooden objects have been retrieved with corkscrews and drinking glasses after filling them with [[plaster]].<ref name="PMID1252815" /><ref>{{cite book | vauthors = Bailey H, Love J | title = A short textbook of surgery. | veditors = Rains AJ, Ritchie HD | edition = 16th | publisher = Verlag Lewis | date = 1975 | pages = 1013 }}</ref> A spoon can be used as an "anchor" by leaving it inside the glass during the plaster filling, removing it together with the glass.<ref name="Spiegel1991" /> Light bulbs are encased in a [[gauze]] shroud, shattered inside the rectum and extracted.<ref name="Spiegel1991" />

There have been successful cases using [[Argon plasma coagulation|argon-plasma coagulation]]. The object in question was a green apple wrapped in [[cellophane]] inside the rectum of a 44-year-old patient. The argon-beam coagulation shrunk the apple by more than 50%, enabling its removal. Previous extraction attempts using endoscopic tools failed due to the flat surface of the object.<ref name="PMID9201486">{{cite journal | vauthors = Glaser J, Hack T, Rübsam M | title = Unusual rectal foreign body: treatment using argon-beam coagulation | journal = Endoscopy | volume = 29 | issue = 3 | pages = 230–1 | date = March 1997 | pmid = 9201486 | doi = 10.1055/s-2007-1004178 | doi-access = free }}</ref>

If the object is too far up, in the area of the ''[[colon sigmoideum]]'', and cannot be removed using one of the above methods, bed rest and sedation can cause the object to descend back into the rectum, where retrieval and extraction are easier.<ref name="PMID984928" />

In difficult cases, a [[laparotomy]] may be necessary. Statistically, this is the case in about 10 percent of patients.<ref name="Messmann2004" /> The large intestine can be manipulated inside the abdominal cavity, making it possible for it to wander in the direction of the anus and be grabbed there. A surgical opening of the large intestines can be indication in very difficult cases, especially if the manipulation of the object may pose a serious health risk. This may be the case with a jammed drug condom.<ref name="Axon2004" />

=== Anaesthesia ===
Mild cases may need a [[sedation]] at most. [[Local anaesthesia|Local]] and [[spinal anaesthesia]] find common use. Difficult interventions may need [[general anaesthesia]]; surgical opening of the abdominal cavity or the colon require it. General anaesthesia can be beneficial for the relaxation of the [[sphincter]].<ref name="Messmann2004" />

=== Aftercare ===
After the surgery, a [[sigmoidoscopy]] – a [[colonoscopy]] focused on the first 60&nbsp;cm of the colon – is good practice in order to rule out possible perforation and injury of the rectum and the ''colon sigmoideum''.<ref name="PMID18666334">{{cite journal | vauthors = Koornstra JJ, Weersma RK | title = Management of rectal foreign bodies: description of a new technique and clinical practice guidelines | journal = World Journal of Gastroenterology | volume = 14 | issue = 27 | pages = 4403–6 | date = July 2008 | pmid = 18666334 | doi = 10.3748/wjg.14.4403 | pmc = 2731197 | doi-access = free }}</ref> Stationary aftercare may be indicated.

=== Examples ===
{| class="wikitable sortable"
|-
! style="background-color:#FFDEAD; text-align:left;"| Object
! style="background-color:#FFDEAD; text-align:left;"| Procedure
! style="background-color:#FFDEAD; text-align:left;"| Anaesthesia
! style="background-color:#FFDEAD; text-align:left;" class="unsortable"| Source
|-
| Ball pen
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID1205104">{{cite journal | vauthors = Richter RM, Littman L | title = Endoscopic extraction of an unusual colonic foreign body | journal = Gastrointestinal Endoscopy | volume = 22 | issue = 1 | pages = 40 | date = August 1975 | pmid = 1205104 | doi = 10.1016/s0016-5107(75)73685-4 }}</ref>
|-
| Water-filled balloon
| Punction
| align="center"| N.A.
|<ref name="PMID892400">{{cite journal | vauthors = Wolf L, Geraci K | title = Colonscopic removal of balloons from the bowel | journal = Gastrointestinal Endoscopy | volume = 24 | issue = 1 | pages = 41 | date = August 1977 | pmid = 892400 | doi = 10.1016/s0016-5107(77)73441-8 }}</ref>
|-
| Chicken bone
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID8056249">{{cite journal | vauthors = Tarnasky PR, Newcomer MK, Branch MS | title = Colonoscopic diagnosis and treatment of chronic chicken bone perforation of the sigmoid colon | journal = Gastrointestinal Endoscopy | year = 1994 | volume = 40 | issue = 3 | pages = 373–5 | pmid = 8056249 | doi = 10.1016/s0016-5107(94)70079-6 }}</ref>
|-
| Toothpick
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID9476787">{{cite journal | vauthors = Over HH, Tözün N, Avşar E | title = Toothpick impaction: treatment by colonoscopy | journal = Endoscopy | volume = 29 | issue = 9 | pages = S60-1 | date = November 1997 | pmid = 9476787 | doi = 10.1055/s-2007-1004339 | doi-access = free }}</ref>
|-
| Apple in cellophane
| Defragmentation using APC
| none
|<ref name="PMID9201486" />
|-
| Glass bottle
| Biopsy forceps
| General anaesthesia
|<ref name="PMID14703278" />
|-
| Vibrator
| Polypectomy sling
| none
|<ref name="PMID14703278" />
|-
| Vial
| [[Sengstaken–Blakemore tube]]
| align="center"| N.A.
|<ref name="PMID1248348">{{cite journal | vauthors = Hughes JP, Marice HP, Gathright JB | title = Method of removing a hollow object from the rectum | journal = Diseases of the Colon and Rectum | year = 1976 | volume = 19 | issue = 1 | pages = 44–5 | pmid = 1248348 | doi = 10.1007/BF02590850 | s2cid = 32232913 }}</ref>
|-
| Vial
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID3677968">{{cite journal | vauthors = Kantarian JC, Riether RD, Sheets JA, Stasik JJ, Rosen L, Khubchandani IT | title = Endoscopic retrieval of foreign bodies from the rectum | journal = Diseases of the Colon and Rectum | volume = 30 | issue = 11 | pages = 902–4 | date = November 1987 | pmid = 3677968 | doi = 10.1007/BF02555435 | s2cid = 3106133 }}</ref>
|-
| Enema tip
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID3677968" />
|-
| Vibrator
| Biopsy forceps
| align="center"| N.A.
|<ref name="PMID3677968" />
|-
| Pencil
| Polypectomy sling
| align="center"| N.A.
|<ref name="PMID7129050">{{cite journal | vauthors = Vemula NR, Madariaga J, Brand DL, Hershey H | title = Colonoscopic removal of a foreign body causing colocutaneous fistulas | journal = Gastrointestinal Endoscopy | volume = 28 | issue = 3 | pages = 195–6 | date = August 1982 | pmid = 7129050 | doi = 10.1016/s0016-5107(82)73057-3 }}</ref>
|-
| Iron rod
| Two-channel endoscope and wires
| align="center"| N.A.
|<ref name="PMID10570362">{{cite journal | vauthors = Ahmed A, Cummings SA | title = Novel endoscopic approach for removal of a rectal foreign body | journal = Gastrointestinal Endoscopy | volume = 50 | issue = 6 | pages = 872–4 | date = December 1999 | pmid = 10570362 | doi = 10.1016/s0016-5107(99)70184-7 }}</ref>
|-
| Bottleneck
| [[Foley catheter]]
| General anaesthesia
|<ref name="PMID16185979">{{cite journal | vauthors = Humes D, Lobo DN | title = Removal of a rectal foreign body by using a Foley catheter passed through a rigid sigmoidoscope | journal = Gastrointestinal Endoscopy | volume = 62 | issue = 4 | pages = 610 | date = October 2005 | pmid = 16185979 | doi = 10.1016/s0016-5107(05)01575-0 }}</ref>
|-
| Spray tank
| [[Achalasy balloon]]
| None
|<ref name="PMID18666334" />
|-
| Sponge-like toy ball
| Suction cup
| General anaesthesia
|<ref name="PMID17375796">{{cite journal | vauthors = Feigelson S, Maun D, Silverberg D, Menes T | title = Removal of a large spherical foreign object from the rectum using an obstetric vacuum device: a case report | journal = The American Surgeon | volume = 73 | issue = 3 | pages = 304–6 | date = March 2007 | doi = 10.1177/000313480707300326 | pmid = 17375796 | s2cid = 39379768 | doi-access = free }}</ref>
|-
| Vibrator
| Forceps and anal dilation
| Local anaesthesia
|<ref name="PMID1252853">{{cite journal | vauthors = Haft JS, Benjamin HB, Wagner M | title = Vaginal vibrator lodged in rectum | journal = British Medical Journal | volume = 1 | issue = 6010 | pages = 626 | date = March 1976 | pmid = 1252853 | pmc = 1639058 | doi = 10.1136/bmj.1.6010.626 }}</ref>
|-
| Vibrator
| Hooked tongs
| Local anaesthesia
|<ref name="PMID902553">{{cite journal | vauthors = Levin SE, Cooperman H, Freilich M, Lomas M | title = The use of a curved uterine vulsellum for removal of rectal foreign bodies: report of a case | journal = Diseases of the Colon and Rectum | volume = 20 | issue = 6 | pages = 532–3 | date = September 1977 | pmid = 902553 | doi = 10.1007/BF02586597 | s2cid = 21593596 }}</ref>
|-
| Bottle of aftershave
| Bone holding forceps with rubber feet
| Spinal anaesthesia
|<ref name="PMID1181166">{{cite journal | vauthors = Siroospour D, Dragstedt LR | title = A large foreign body removed through the intact anus: report of a case | journal = Diseases of the Colon and Rectum | volume = 18 | issue = 7 | pages = 616–9 | date = October 1975 | pmid = 1181166 | doi = 10.1007/BF02587145 | s2cid = 1613704 }}</ref>
|-
| Chicken bone
| Fingers
| None
|<ref name="PMID1854398" />
|-
| Aerosol-can cap
| [[Grasping forceps]] and anal dilation
| General anaesthesia
|<ref name="PMID3757713">{{cite journal | vauthors = Aquino MM, Turner JW | title = A simple technique for removing an impacted aerosol-can cap from the rectum | journal = Diseases of the Colon and Rectum | volume = 29 | issue = 10 | pages = 675 | date = October 1986 | pmid = 3757713 | doi = 10.1007/BF02560339 | s2cid = 26361937 }}</ref>
|-
| Vase
| Filling with plaster
| General anaesthesia
|<ref name="PMID3713565">{{cite journal | vauthors = Couch CJ, Tan EG, Watt AG | title = Rectal foreign bodies | journal = The Medical Journal of Australia | volume = 144 | issue = 10 | pages = 512–5 | date = May 1986 | doi = 10.5694/j.1326-5377.1986.tb112273.x | pmid = 3713565 | s2cid = 29114662 }}</ref>
|-
| Glass container
| Extraction using plaster
| Spinal anaesthesia
|<ref name="PMID6844979">{{cite journal | vauthors = Graves RW, Allison EJ, Bass RR, Hunt RC | title = Anal eroticism: two unusual rectal foreign bodies and their removal | journal = Southern Medical Journal | volume = 76 | issue = 5 | pages = 677–8 | date = May 1983 | doi = 10.1097/00007611-198305000-00041 | pmid = 6844979 }}</ref>
|-
| Glass container
| [[Tracheal tube]]
| Local anaesthesia
|<ref name="PMID7238244">{{cite journal | vauthors = Garber HI, Rubin RJ, Eisenstat TE | title = Removal of a glass foreign body from the rectum | journal = Diseases of the Colon and Rectum | year = 1981 | volume = 24 | issue = 4 | pages = 323 | pmid = 7238244 }}</ref>
|-
| Apple
| Two-handed manipulation
| Local anaesthesia
|<ref name="PMID17357869">{{cite journal | vauthors = Sharma H, Banka S, Walton R, Memon MA | title = A novel technique for nonoperative removal of round rectal foreign bodies | journal = Techniques in Coloproctology | volume = 11 | issue = 1 | pages = 58–9 | date = March 2007 | pmid = 17357869 | doi = 10.1007/s10151-007-0328-z | s2cid = 22770266 }}</ref>
|-
| Glass container
| Foley catheter
| General anaesthesia
|<ref name="PMID8472230">{{cite journal | vauthors = Yaman M, Deitel M, Burul CJ, Shahi B, Hadar B | title = Foreign bodies in the rectum | journal = Canadian Journal of Surgery. Journal Canadien de Chirurgie | volume = 36 | issue = 2 | pages = 173–7 | date = April 1993 | pmid = 8472230 }}</ref>
|-
| Glass bottle
| Suction cup
| General anaesthesia
|<ref name="PMID9887927" />
|-
| 100-watt electric bulb
| Three Foley catheters
| align="center"| N.A.
|<ref name="PMID7137678">{{cite journal | vauthors = Diwan VS | title = Removal of 100-watt electric bulb from rectum | journal = Annals of Emergency Medicine | volume = 11 | issue = 11 | pages = 643–4 | date = November 1982 | pmid = 7137678 | doi = 10.1016/s0196-0644(82)80218-7 }}</ref>
|-
| Thermometer
| Biopsy forceps
| General anaesthesia
|<ref name="PMID14703278" />
|-
| Vibrator
| transanal [[Kocher's forceps]]
| Local anaesthesia
|<ref name="PMID14703278" />
|-
| Bowling bottle (Bottle in the shape of a pin)
| Forceps
| General anaesthesia
|<ref name="PMID14703278" />
|-
| Perfume bottle
| manual
| Spinal anaesthesia
|<ref name="PMID3738771" />
|-
| Piece of wood
| manual
| General anaesthesia
|<ref name="PMID5259744">{{cite journal | vauthors = Jansen AA | title = Foreign body in the rectum | journal = The New Zealand Medical Journal | volume = 70 | issue = 448 | pages = 174–5 | date = September 1969 | pmid = 5259744 }}</ref>
|-
| Toothbrush container
| [[Fogarty catheter]]
| align="center"| N.A.
|<ref name="PMID3291887">{{cite journal | vauthors = Wigle RL | title = Emergency department management of retained rectal foreign bodies | journal = The American Journal of Emergency Medicine | volume = 6 | issue = 4 | pages = 385–9 | date = July 1988 | pmid = 3291887 | doi = 10.1016/0735-6757(88)90163-5 }}</ref>
|-
| [[Oven mitt]]
| Forceps, after anal dilation
| General anaesthesia
|<ref name="PMID9950383">{{cite journal | vauthors = Losanoff JE, Kjossev KT | title = Rectal "oven mitt": the importance of considering a serious underlying injury | journal = The Journal of Emergency Medicine | year = 1999 | volume = 17 | issue = 1 | pages = 31–3 | pmid = 9950383 | doi = 10.1016/s0736-4679(98)00116-4 }}</ref>
|-
| Drainpipe
| [[Forceps|forceps in childbirth]]
| General anaesthesia
|<ref name="PMID1252815" />
|-
| [[Pétanque]] ball
| Electromagnet
| General anaesthesia
|<ref name="PMID15322838">{{cite journal | vauthors = Coulson CJ, Brammer RD, Stonelake PS | title = Extraction of a rectal foreign body using an electromagnet | journal = International Journal of Colorectal Disease | volume = 20 | issue = 2 | pages = 194–5 | date = March 2005 | pmid = 15322838 | doi = 10.1007/s00384-004-0629-x | s2cid = 35914504 }}</ref>
|-
| Carrot
| Myoma lifter
| align="center"| N.A.
|<ref name="PMID9248200">{{cite journal | vauthors = Vashist MG, Arora AL | title = Screwing a carrot out of the rectum | journal = Indian Journal of Gastroenterology | volume = 16 | issue = 3 | pages = 120 | date = July 1997 | pmid = 9248200 }}</ref>
|-
| Glass object
| Suction cup
| Spinal anaesthesia
|<ref name="PMID8756851">{{cite journal | vauthors = Johnson SO, Hartranft TH | title = Nonsurgical removal of a rectal foreign body using a vacuum extractor. Report of a case | journal = Diseases of the Colon and Rectum | volume = 39 | issue = 8 | pages = 935–7 | date = August 1996 | pmid = 8756851 | doi = 10.1007/BF02053994 | s2cid = 11204678 }}</ref>
|-
| Rubber ball
| manual extraction after anal dilation
| General anaesthesia
|<ref name="PMID16798498">{{cite journal | vauthors = Nivatvongs S, Metcalf DR, Sawyer MD | title = A simple technique to remove a large object from the rectum | journal = Journal of the American College of Surgeons | volume = 203 | issue = 1 | pages = 132–3 | date = July 2006 | pmid = 16798498 | doi = 10.1016/j.jamcollsurg.2006.03.012 }}</ref>
|-
| Wooden staff
| Two-handed anal dilation
| Spinal anaesthesia
|<ref name="PMID16798498" />
|-
| Bottle
| manual after anal dilation
| General anaesthesia
|<ref name="PMID4839771">{{cite journal | vauthors = Gopal S | title = A bottle in the rectum | journal = Journal of the Indian Medical Association | volume = 62 | issue = 1 | pages = 24–5 | date = January 1974 | pmid = 4839771 }}</ref>
|-
| Dildo
| Myoma lifter
| align="center"| N.A.
|<ref name="PMID12908471">{{cite journal | vauthors = Clark SK, Karanjia ND | title = A cork in a bottle--a simple technique for removal of a rectal foreign body | journal = Annals of the Royal College of Surgeons of England | volume = 85 | issue = 4 | pages = 282 | date = July 2003 | pmid = 12908471 | doi = 10.1308/003588403766275060 | pmc = 1964392 }}</ref>
|-
| Light bulb
| Abdominal compression
| Spinal anaesthesia
|<ref name="PMID17164965">{{cite journal | vauthors = Konishi T, Watanabe T, Nagawa H | title = Impaction of a rectal foreign body: what is the final approach before surgery? | journal = Diseases of the Colon and Rectum | volume = 50 | issue = 2 | pages = 262–3; author reply 263 | date = February 2007 | pmid = 17164965 | doi = 10.1007/s10350-006-0788-7 | s2cid = 1099599 }}</ref>
|}
: <small>APC = Argon beam-coagulation</small>
: <small>N.A. = Not available</small>
(Source:<ref name="PMID18666334" />)

== Epidemiology ==

There is no reliable data about the [[Incidence (epidemiology)|incidence]] of clinically meaningful foreign rectal bodies. It may have increased in the long term<ref name="Munter2009">{{cite web | vauthors = Munter DW | url =  http://emedicine.medscape.com/article/776795-overview | title = Foreign Bodies, Rectum. | date = September 2009 }}</ref> as it is observed more often in recent times.<ref name="PMID18662236">{{cite journal | vauthors = Manimaran N, Shorafa M, Eccersley J | title = Blow as well as pull: an innovative technique for dealing with a rectal foreign body | journal = Colorectal Disease| volume = 11 | issue = 3 | pages = 325–6 | date = March 2009 | pmid = 18662236 | doi = 10.1111/j.1463-1318.2008.01653.x | s2cid = 29092891 }}</ref>

The incident rate is significantly higher for men than for women. The gender ratio is in the area of 28:1.<ref name="Munter2009" /><ref name="PMID15606596">{{cite journal | vauthors = Clarke DL, Buccimazza I, Anderson FA, Thomson SR | title = Colorectal foreign bodies | journal = Colorectal Disease | volume = 7 | issue = 1 | pages = 98–103 | date = January 2005 | pmid = 15606596 | doi = 10.1111/j.1463-1318.2004.00699.x | s2cid = 25964610 }}</ref><ref>{{cite journal | vauthors = Stack LB, Munter DW | title = Foreign bodies in the gastrointestinal tract | journal = Emergency Medicine Clinics of North America | volume = 14 | issue = 3 | pages = 493–521 | date = August 1996 | pmid = 8681881 | doi = 10.1016/s0733-8627(05)70264-9 }}</ref> A [[metaanalysis|metastudy]] in the year 2010 found a ratio of 37:1. Median age of the patients was 44.1 years, with a [[standard deviation]] of 16.6 years.<ref name="PMID19895597">{{cite journal | vauthors = Kurer MA, Davey C, Khan S, Chintapatla S | title = Colorectal foreign bodies: a systematic review | journal = Colorectal Disease | volume = 12 | issue = 9 | pages = 851–61 | date = September 2010 | pmid = 19895597 | doi = 10.1111/j.1463-1318.2009.02109.x  | s2cid = 8776335 }}</ref> Rectal foreign bodies are not an unusual occurrence in hospital emergency rooms.<ref name="PMID17375796"/>

The first documented case dates from the 16th century.<ref name="PMID18925957" /><ref>{{cite journal | vauthors = Haft JS, Benjamin HB | title = Foreign bodies in the rectum: some psychosexual aspects. | journal = Medical Aspects of Human Sexuality. | date = August 1973 | volume = 7 | issue = 8 | pages = 74–95 }}</ref>

== Other animals ==
Foreign rectal bodies are rare in [[veterinary medicine]]. A passage through the entire intestines, followed by a stay inside the rectum is – as with humans – rare.<ref>{{cite journal | vauthors = Webb CB, McCord KW, Twedt DC | title = Rectal strictures in 19 dogs: 1997-2005 | journal = [[Journal of the American Animal Hospital Association]] | year = 2007 | volume = 43 | issue = 6 | pages = 332–6 | pmid = 17975215 | doi = 10.5326/0430332 }}</ref> Animals may have [[bezoar]]s out of different materials, which may migrate to the rectum and cause problems.<ref>{{cite journal | vauthors = Sargison ND, Scott PR, Dun KA | title = Intestinal obstruction in a blue-faced Leicester ram associated with a phytobezoar lodged at the pelvic inlet | journal = The Veterinary Record | volume = 137 | issue = 9 | pages = 222 | date = August 1995 | pmid = 7502475 | doi = 10.1136/vr.137.9.222 | doi-broken-date = July 12, 2025 | s2cid = 27561735 }}</ref>

== Ig Nobel Prize ==
The [[Ig Nobel Prize]] was awarded in 1995 to David B. Busch and James R. Starling from [[Madison, Wisconsin]], for their 1986 article ''Rectal foreign bodies: Case Reports and a Comprehensive Review of the World's Literature''<ref name="PMID3738771">{{cite journal | vauthors = Busch DB, Starling JR | title = Rectal foreign bodies: case reports and a comprehensive review of the world's literature | journal = Surgery | volume = 100 | issue = 3 | pages = 512–9 | date = September 1986 | pmid = 3738771 }}</ref> (see [[List of Ig Nobel Prize winners]]).<ref>Improbable Research: [http://improbable.com/ig/winners/ ''Winners of the Ig® Nobel Prize.'']</ref>

== See also ==
* [[Đorđe Martinović incident]]
* [[Foreign body in alimentary tract]]
* [[urethral foreign body|Urethral foreign body insertion]]
* [[Butt plug]]

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB      = 
|  ICD10           = {{ICD10|T18.5}}
|  ICD9            = {{ICD9|937}}
|  ICDO            = 
|  OMIM            = 
|  MedlinePlus     = 
|  MeSH            = 
|  GeneReviewsNBK  = 
|  GeneReviewsName = 
}}
{{Commons category|Rectal foreign bodies}}
* [http://www.emedicine.com/emerg/topic933.htm eMedicine gastrointestinal emergency medicine]
* [http://www.mja.com.au/public/issues/xmas98/mkinnon/mkinnon.html Medical Journal of Australia] {{Webarchive|url=https://web.archive.org/web/20120218211904/http://www.mja.com.au/public/issues/xmas98/mkinnon/mkinnon.html |date=February 18, 2012 }}
* British Dental Journal case report: [http://www.nature.com/cgi-taf/DynaPage.taf?file=/bdj/journal/v191/n1/full/4801082a.html Don't forget your toothbrush!] (subscribers only - with useful bibliography)
* [http://chilearning.charite.de/index.php?id=92 X-rays of rectal bodies] {{Webarchive|url=https://web.archive.org/web/20160304062951/http://chilearning.charite.de/index.php?id=92 |date=March 4, 2016 }} at the [[Berlin Charité]]
* [http://www.spiegel.de/spiegel/print/d-13491232.html ''Sturz in die Kiste.''] In: ''[[Der Spiegel]]'' Ausgabe 41, 1991, S.&nbsp;317–320.
* [http://einestages.spiegel.de/static/entry/lachsalven_aus_dem_labor/35617/alles_im_a.html?o=position-ASCENDING&s=4&r=1&a=5125&c=1 ''Alles im A…''] In: ''einestages'' vom 7. Juni 2007

[[Category:Anal eroticism]]
[[Category:Medical emergencies]]
[[Category:Rectum]]
[[Category:Foreign body]]