Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Langenbecks Arch Surg. 2022 Sep;407(6):2499-2508. doi: 10.1007/s00423-022-02571-z. Epub 2022 Jun 2.
Retained rectal foreign bodies (RFBs) are uncommon clinical findings. Although the management of RFBs is rarely reported in the literature, clinicians regularly face this issue. To date, there is no standardized management of RFBs. The aim of the present study was to evaluate our own data and subsequently develop a treatment algorithm.
All consecutive patients who presented between January 2006 and December 2019 with rectally inserted RFBs at the emergency department of the Klinikum Stuttgart, Germany, were retrospectively identified. Clinicopathologic features, management, complications, and outcomes were assessed. Based on this experience, a treatment algorithm was developed.
A total of 69 presentations with rectally inserted RFBs were documented in 57 patients. In 23/69 cases (33.3%), the RFB was removed transanally by the emergency physician either digitally (n = 14) or with the help of a rigid rectoscope (n = 8) or a colonoscope (n = 1). In 46/69 cases (66.7%), the RFB was removed in the operation theater under general anesthesia with muscle relaxation. Among these, 11/46 patients (23.9%) underwent abdominal surgery, either for manual extraction of the RFB (n = 9) or to exclude a bowel perforation (n = 2). Surgical complications occurred in 3/11 patients. One patient with rectal perforation developed pelvic sepsis and underwent abdominoperineal extirpation in the further clinical course.
The management of RFBs can be challenging and includes a wide range of options from removal without further intervention to abdominoperineal extirpation in cases of pelvic sepsis. Whenever possible, RFBs should obligatorily be managed in specialized colorectal centers following a clear treatment algorithm.
直肠内异物残留（RFB）是一种少见的临床发现。尽管文献中很少有关于 RFB 处理的报道，但临床医生经常会遇到这个问题。迄今为止，RFB 尚无标准化的处理方法。本研究旨在评估我们自己的数据，并在此基础上制定一个治疗方案。
回顾性分析 2006 年 1 月至 2019 年 12 月期间在德国斯图加特 Klinikum 急诊科因直肠插入 RFB 而就诊的所有连续患者。评估了临床病理特征、处理方法、并发症和结局。基于这些经验，制定了一个治疗方案。
共记录了 57 例患者中 69 例直肠插入 RFB 的病例。在 23/69 例（33.3%）中，RFB 由急诊医生经肛门通过手指（n=14）或使用硬性直肠镜（n=8）或结肠镜（n=1）取出。在 46/69 例（66.7%）中，RFB 在全身麻醉下由外科医生在手术室取出，其中 11/46 例（23.9%）患者接受了腹部手术，要么是手动取出 RFB（n=9），要么是排除肠穿孔（n=2）。3/11 例患者发生手术并发症。1 例直肠穿孔患者发生骨盆脓毒症，在进一步的临床病程中接受了腹会阴联合切除术。
RFB 的处理具有挑战性，包括从无需进一步干预的取出到发生骨盆脓毒症时进行腹会阴联合切除术等多种选择。只要有可能，RFB 就应该在专门的结直肠中心按照明确的治疗方案进行处理。
