Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects

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The amount of patients presenting at the emergency hospitals with retained rectal foreign bodies appears recently to have increased. Foreign objects retained in the rectum may result from direct introduction through the anus (more common) or from ingestion. Affected individuals often make ineffective attempts to extract the object themselves, resulting in additional delay of medical care and potentially increasing the risk of complications. The goals of radiological patient assessment are to identify the type of object retained, its location, and the presence of associated complications. Plain film radiographs still play an important role in the assessment of retained rectal foreign bodies.

Introduction

Presentation at the emergency department with retained rectal foreign bodies is not uncommon, although there are no reliable epidemiological data available.1 Foreign bodies in the rectum are usually found in the adult population; they can be introduced into the rectum for diagnostic and therapeutic procedures, self-administered treatment, autoeroticism, accidental introduction, and criminal assault.2, 3, 4 Some psychiatric patients or prisoners purposefully conceal sharp objects in their rectum with the intention of harming their carers, fellow patients, prisoners, or guards.5 There is a male preponderance in published literature.3, 5, 6, 7, 8, 9, 10 Some authors have reported the male-to-female ratio to be as high as 28:1.3, 5

A foreign body inside the anorectal area has various causes, which will determine treatment, as will the symptoms and the severity of the anorectal damage.11

This review illustrates a range of foreign bodies inserted in the rectum and discusses the role of plain film radiographs and multidetector row computed tomography (MDCT) in the assessment of rectal foreign bodies. Pertinent medicolegal issues are also described.

Section snippets

Pertinent Anatomy

The length of the anal canal, defined as the distance from the upper aspect of the puborectalis sling to the anal verge, is about 4 cm.12 The outer musculature of the anal canal consists of the puborectalis sling and the external sphincter muscles. These are voluntary striated muscles that are important in maintaining continence, particularly at times of increased intra-abdominal pressure.

The rectum represents the distal-most aspect of the gastrointestinal tract, approximately 15 cm in length,

Types of Rectal Foreign Bodies

As with upper gastrointestinal foreign bodies, the types of objects introduced through the anus are unlimited. A useful classification of rectal foreign bodies has been to categorize them as voluntary vs involuntary and sexual vs nonsexual. One of the most common category of rectal foreign bodies is objects that are inserted voluntarily and for sexual stimulation.14 In fact, autoeroticism has been reported as the most common reason for anally inserted foreign bodies.7 Objects such as vibrators (

Plain Radiographs and CT Evaluation

The diagnosis and management of rectal foreign bodies can be difficult because of shame or embarrassment felt by the patients, which often leads to delayed presentation.6, 16, 17, 18

Patients usually present to the emergency department because of anorectal, pelvic, or lower abdominal pain, often after failure of multiple attempts to remove the object.16, 19 The delay in presentation and multiple attempts at self-retrieval frequently lead to mucosal edema and muscular spasms, which further hinder

Medicolegal Aspects

The diagnosis and management can present a significant challenge because of delayed presentation and the hesitancy of the patients to specify details of the incident.

The unsuspecting medical practitioner may easily miss the diagnosis and fail to institute timely appropriate treatment.

Sometimes, patients may formulate unusual stories to explain how the object became lodged in the rectum, including accidentally sitting on the object or insertion by an unknown assailant while asleep or drunk.

Less

Conclusions

The insertion of foreign objects into the anus and rectum is a well-described phenomenon and can no longer be considered rare.

Rectal foreign bodies are inserted intentionally or nonintentionally and pose both a diagnostic and therapeutic challenge to the clinician. Foreign bodies that are retained in the rectum have various shapes, numbers, and sizes.

Presentation with anorectal foreign body is usually delayed because of the patient׳s embarrassment. After emergency or hospital admission,

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