Cohen J S, Sackier J M
Department of Surgery, University of California, San Diego, La Jolla, USA.
J R Coll Surg Edinb. 1996 Oct;41(5):312-5.
Colorectal foreign bodies (CFBs) present a serious dilemma regarding extraction and management. In an 11-year period ending March 1994, 48 patients presented to the University of California, San Diego Medical Center and Hammersmith Hospital London with CFBs. Identified patients charts were reviewed in a retrospective manner and the medical literature was reviewed. A wide variety of CFBs were identified and all were extracted transanally. Circumstances surrounding CFB insertion was most commonly sexual stimulation (78%), but included sexual assault (10%). Extraction in the emergency department was successful in 31 (63%) patients. Operating room extraction was performed in 18 (37%) patients; in 12 cases the CFBs were simply extracted under anaesthesia, five patients required primary repair and diverting colostomy for rectal perforation and one required primary repair of an external anal sphincter laceration. Post-extraction observation following simple extraction ranged from immediate discharge to 72 h (mean 13.1 h) and there were no reported complications. A thorough history is essential in order to identify those cases that have resulted from assaults. With adequate sedation, most CFBs can be extracted transanally either in the emergency department or operative suite under direct vision. Sigmoidoscopy is required following extraction to evaluate mucosal injury or perforation. After effortless extraction of a smooth object, with no evidence of mucosal injury, the patient can be discharged after a short period of observation. Rectal perforation can be treated with primary repair and diverting colostomy with low morbidity. This is a relatively common surgical dilemma that requires a thorough history, physical examination, radiographs inventiveness to treat. Additionally, the physician should demonstrate a caring attitude and not subject the patient who is suffering pain and embarrassment to ridicule.
结直肠异物（CFBs）在取出和处理方面存在严重难题。在截至1994年3月的11年期间，48例结直肠异物患者就诊于加利福尼亚大学圣地亚哥分校医学中心和伦敦哈默史密斯医院。对确诊患者的病历进行了回顾性分析，并查阅了医学文献。发现了各种各样的结直肠异物，所有异物均经肛门取出。结直肠异物插入的情况最常见的是性刺激（78%），但也包括性侵犯（10%）。31例（63%）患者在急诊科成功取出异物。18例（37%）患者在手术室取出异物；其中12例异物仅在麻醉下取出，5例患者因直肠穿孔需要一期修复并做转流性结肠造口术，1例患者需要对外括约肌撕裂伤进行一期修复。单纯取出异物后的术后观察时间从立即出院到72小时不等（平均13.1小时），且无并发症报告。为了识别那些由性侵犯导致的病例，详细的病史至关重要。在充分镇静的情况下，大多数结直肠异物可在急诊科或手术室直视下经肛门取出。取出异物后需要进行乙状结肠镜检查以评估黏膜损伤或穿孔情况。顺利取出光滑物体且无黏膜损伤证据的患者，经过短时间观察后即可出院。直肠穿孔可通过一期修复和转流性结肠造口术治疗，发病率较低。这是一个相对常见的外科难题，需要详细的病史、体格检查、影像学检查及创新的治疗方法。此外，医生应表现出关怀的态度，不要让遭受疼痛和尴尬的患者受到嘲笑。
