Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness

Abstract

Background Entrapped rectal foreign bodies can be a challenge to manage and are being encountered by acute surgical teams with increasing frequency. The aims of our study were to (a) ascertain the population demographics of patients presenting with this problem in our local area of East Kent, (b) see if an association could be drawn between this presentation and proposed risk factors such as a psychiatric illness or socioeconomic deprivation, and (c) to review how foreign bodies are being removed in the East Kent Hospital University Foundation NHS Trust, United Kingdom and to highlight best practice with regards to this in line with the latest guidelines. Methodology Between 2017 and 2021, 32 cases of entrapped rectal foreign bodies were diagnosed and managed at our NHS Trust. Retrospective data taken from the theatre directory and electronic patient records were used to audit patient demographics, co-morbidities, the type of foreign body, and the extraction technique. Results The majority of patients (90%) were male (n = 29). The patients' age ranged from 15 to 95 years, with a median age of 48 years. In total, 12 (37.5%) patients had a medical history of a psychiatric illness. The most common foreign bodies removed were sex toys or vibrators (n = 8) and roll-on deodorant bottles (n = 7). Kent Area B (n = 10) and Kent Area A (n = 9) were the areas with the highest number of cases. Twenty-two (68.8%) patients underwent examination under a general anaesthetic for removal, seven (21.8%) patients had the object manually removed without sedation, and three (9.4%) required a laparotomy with or without bowel resection. Conclusions Cases of an entrapped rectal foreign body in this local region typically involved male patients between 40 and 50 years old. A high proportion of this group had a history of a psychiatric illness supporting an association between this presentation and mental health. We have proposed some explanations for this association including the anal canal nervous system interplay with the "brain-gut axis." Lower socioeconomic status and unemployment may also be risk factors for this surgical problem. A trans-anal approach for management is successful in the majority of cases; however, almost 10% of patients required emergency surgical management. We have highlighted best practice guidelines for the investigation and management of the entrapped rectal foreign body as part of our discussion.

Keywords: anorectal trauma; foreign body; mental health; rectum; surgical management.

Figure 1. Breakdown of patient co-morbidities.

Figure 2. Cases of entrapped rectal foreign bodies as per the local authority area.

Figure 3. Cases of entrapped rectal foreign body as per postcode in the (a) Kent Area A and (b) Kent Area B local authority areas.

Figure 4. Types of entrapped rectal foreign body removed in this study group.

Figure 5. Radiological images of study cases on presentation: (a) hand torch, (b) roll-on deodorant, (c) glass candle holder, (d) bathroom sealant applicator, (e) narcotics, and (f) sex toy/vibrator.

Figure 6. Extraction methods required in this study group to manage the entrapped rectal foreign body, including surgical management, examination under general anaesthesia, and manual evacuation without sedation in the emergency department.

EUA = examination under anaesthesia

Figure 7. The Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS).