Rectum Foreign Body Removal

Rectal foreign bodies (RFBs) have been documented in medical literature for centuries, with one of the earliest recorded cases dating to the 16th century. In modern clinical practice, RFB presentations are increasingly observed in emergency departments, particularly in urban settings. Reported cases of RFBs span a wide age range from infancy to over 90 years, with most adult patients being male. Among male patients, presentations show a bimodal age distribution with a prominent peak in the 40s, while female patients tend to present at younger ages. Emergency department visits involving older men have also shown a marked increase in recent years. Despite this rising incidence, no universal clinical guidelines currently exist to standardize management, leading to wide variation in practice. Glass bottles are the most frequently reported RFBs, accounting for approximately 42.2% of cases. Other materials that have reportedly been recovered include sex toys, household objects, fruits and vegetables, aerosol cans, lightbulbs, tools, and drug packets. Motivations for rectal insertion include sexual gratification, concealment in the context of body packing, and sexual assault. In some cases, foreign body insertion may result from accidental events. Autoeroticism remains the most common underlying factor, paralleling a growing trend in the use of nonmedical objects for anal sexual activity. The timing of presentation varies widely. Some individuals seek immediate emergency care due to significant discomfort or inability to retrieve the object, while others delay for several days or even weeks, often because of embarrassment or other psychosocial barriers. In some cases, patients may attempt self-extraction before obtaining medical attention, which not only delays appropriate management but may also increase the risk of mucosal injury or deeper impaction. Upon arrival at the emergency department, many patients hesitate to disclose the true cause of their symptoms and, instead, report nonspecific complaints such as rectal bleeding, pain, or constipation, further contributing to delays in recognition and treatment. RFB retention constitutes an emergency because of the risk of serious complications, including rectal or colonic perforation, hemorrhage, bowel obstruction, mucosal necrosis, and infection. Delayed recognition or removal increases the likelihood of these outcomes and may result in surgical intervention or sepsis. Advancements in medical technology have expanded the available methods for RFB removal to include minimally invasive surgical options such as endoscopy and laparoscopy. However, emergency medicine physicians must be prepared to evaluate and manage RFBs nonoperatively, as timely intervention can prevent the need for surgery and its associated risks. With proper technique and preparation, many cases can be safely and effectively managed in the emergency department, minimizing long-term complications.