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lunes, 21 de enero de 2019

Rectal Foreign Bodies

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emDocs - January 21, 2019 - Authors: Barrineau T, Davee D, Mosley C
Edited by: Koyfman A and Long B
"Key Points
  • Patients may not initially volunteer information.
  • Maintain nonjudgmental attitude and professionalism.
  • Labs/Imaging may potentially not provide any insight to problem; history is key!
  • Predictors of failure include sharp or hard objects, longer than 10cm, located in the sigmoid colon, and those objects that have been retained for more than 2 days.
  • Set a time limit and use a stepwise approach in management:
    1. Imaging
    2. Lubrication/DRE
    3. Perianal block/DRE
    4. Speculum/Grasping tools/Foley catheter placement
    5. Avoid pushing the object deeper
    6. Do not blindly grab with instrument, can lead to perforation
    7. Do not attempt to remove sharp objects or objects that may be sharp if they break
    8. General Surgery consult
  • If the object is unreachable or sharp consult surgery.
  • If the patient has peritoneal signs consult surgery immediately, administer antibiotics, and resuscitate."