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:
- Imaging
- Lubrication/DRE
- Perianal block/DRE
- Speculum/Grasping tools/Foley catheter placement
- Avoid pushing the object deeper
- Do not blindly grab with instrument, can lead to perforation
- Do not attempt to remove sharp objects or objects that may be sharp if they break
- 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."