Novel Approach to Removal of Rectal Foreign Bodies

BACKGROUND: Retained rectal foreign bodies are a common concern in patients presenting to the emergency department. Thankfully, the rates of injury from these retained objects are low. Numerous techniques have been described for the extraction of these foreign bodies, including using endoscopic snares, Foley catheters to break suction mechanisms, and various kinds of clamps to grasp the objects. Some foreign bodies may not be amenable to snaring or grasping with forceps. We describe the use of laparoscopic specimen extraction bags to remove such objects. TECHNIQUE: The patient is placed in the lithotomy position under the appropriate level of anesthesia. The extraction bag is opened out of the pouch, and the metallic ring is lubricated. The ring is then compressed with 1 hand and gently guided into the rectum between the rectal wall and the foreign body with the other hand. The ring is then allowed to expand, and the foreign body is encircled. The bag is then closed around it, and the object is removed. RESULTS: The specimen-extraction bag works especially well for spherical objects and objects that are hard to grasp with clamps. We were able to extract a billiard ball and a glitter ball with this technique. It has minimal risk of injury to the rectum. CONCLUSIONS: Colorectal surgeons have a wide array of tools to use, and it is prudent to cater the tool to the task at hand. We can refashion the laparoscopic specimen extraction bag for removal of certain foreign bodies. It behooves the surgeon to consider all the tools at his or her disposal and to consider the best one for the job.