For patients who are operative candidates due to the presence of peritoneal signs, signs of sepsis or perforation, or for rectal foreign bodies that cannot be removed in the ED, routine preoperative lab studies should be obtained. Flat plate of the abdomen or pelvis is indicated. The foreign object can be identified and localized in most cases. An upright chest radiograph is indicated to evaluate for free air under the diaphragms if perforation is indicated. Transport the patient in a position of comfort.
Fluid resuscitation is indicated in cases of hypotension due to sepsis or hemorrhage.
After the radiographs have been reviewed and no dangerous or sharp foreign body is present, a rectal exam should be performed. The presence of frank blood is an indication of laceration or perforation, and patient should be referred to surgery for evaluation. If the foreign body is palpated on rectal exam, the object is considered to be low-lying and a candidate for ED removal. The key elements of successful ED removal are visualization and sedation. Patient will often have developed rectal edema or spasm, so adequate sedation and analgesia are required.