Management and Removal of Foreign Bodies in the Emergency Department
Condition: Rectal Foreign Body; Rectal Perforation; Colonic Perforation
MeSH terms: Foreign Bodies
Study type: Observational

Summary: 
      Management of rectal foreign bodies presents unique challenges in the emergency department.
      Rectal foreign bodies may consist of various compositional materials and ergonomics which
      include but are not limited to vegetables, light bulbs, everyday household items, and body
      packing of illicit drugs. Patients presenting to the emergency department with rectal foreign
      bodies range widely in age from prepubertal patients to older adults. Insertion of rectal
      foreign bodies have been classified as voluntary or involuntary, as well as sexual or
      non-sexual. The definition of rectal foreign bodies can be blurry, as many objects inserted
      via the rectum are large enough to enter the sigmoid colon. Although detailed epidemiologic
      data are scant, recent studies reported a progressive rise in complications related to rectal
      foreign bodies with incidence disproportionately higher in men and an average age in the mid
      40s.
    

Detailed description: 
      rectal foreign bodies have been reported to result in a varying range of complications.
      According to the Rectal Organ Injury Scale (ROIS) proposed by the American Association for
      the Surgery of Trauma, injuries caused by rectal foreign bodies range from Grade I to Grade
      V. Grade I injury is defined as hematoma without devascularization. Grade II injury includes
      partial thickness laceration less than 50% of circumference while Grade III injury
      demonstrates partial thickness laceration greater than 50% of circumference. Grade IV injury
      is noted as a full-thickness laceration extending into the perineum. Grade V injury
      demonstrates devascularized segment. Colonic organ injury scale grading is very similar to
      the ROIS with differences consisting of transection of the colon in grade IV and transection
      of the colon with devascularized segment and tissue loss in grade V. Prior studies suggest
      that most injuries resulting from inserted objects are classified as Grade I injuries.

      Investigators from two separate studies suggested a nearly 10% complication rate in cases of
      attempted transanal bedside removals in the ED. The most commonly reported complications of
      bedside procedures were perforation of the rectum, followed by the rectal mucosal injury. One
      particular study noted that 17% of patients sustained perforation of colon. The underlying
      cause for such high rates of complications may be multifactorial, including the status of the
      patients, the presence of comorbidities, and delays in presentation to the hospital. To
      reduce the rate of complication various extraction methods such as the use of sigmoidoscopy.
      With the increased incidence of rectal foreign bodies and the associated complications, it is
      imperative to explore and determine a set of standards for the safe and effective removal of
      rectal foreign bodies. However, current literature is not clear as to the ideal setting. This
      study aims to further explore various methods of extraction, outcomes and complications
      associated with bedside attempts at removal of rectal foreign bodies.
    

Intervention name(s): No Intervention
Intervention type(s): Other
Intervention description(s): Difference in outcomes in patients with rectal foreign bodies removed in the emergency department or in the operating room.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        To evaluate the safety of foreign body removals in the emergency department and in the
        operating room in patients older than 18 years of age.