Management of anorectal foreign bodies: a cause of obscure anal pain.
BACKGROUND
Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long-term follow-up in these patients have been sparse.


METHODS
Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long-term outcomes were obtained by telephone interview.


RESULTS
Thirty patients (25 men, 5 women) with a mean age of 46 (range 16-72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X-ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X-rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long-term faecal incontinence or re-impaction of foreign bodies at 63 (range 8-96) months of follow-up.


CONCLUSIONS
Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short- and long-term complications.
Ooi
B S
BS
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Ho
Y H
YH
Eu
K W
KW
Nyam
D
D
Leong
A
A
Seow-Choen
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D000768:Anesthesia, General; D001996:Bronchopneumonia / Q000209:etiology; D012809:Colon, Sigmoid / Q000293:injuries; D016292:Procedural Sedation; D019992:Databases as Topic; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007407:Interviews as Topic; D007416:Intestinal Perforation / Q000209:etiology; D007813:Laparotomy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009093:Mucus; D009119:Muscle Contraction / Q000502:physiology; D010146:Pain / Q000209:etiology; D010173:Palpation; D011446:Prospective Studies; D011859:Radiography; D012007:Rectum; D016896:Treatment Outcome