Guideline sources The following summarized guidelines for the evaluation and management of rectal foreign body are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2021). 1 Guidelines 1. Diagnostic investigations Clinical examination: Consider eliciting a focused medical history and performing a complete physical examination in patients with suspected retained anorectal foreign body. C Consider performing DRE after the acquisition of an abdominal XR, whenever possible, in patients with suspected retained anorectal foreign body to prevent accidental injury to the surgeon from sharp objects. C Diagnostic imaging: Obtain lateral and anteroposterior plain X-ray of the chest, abdomen, and pelvis in patients with suspected retained anorectal foreign body to identify the foreign body position and determine its shape, size, and location and the possible presence of pneumoperitoneum. B https://web.pathway.md/diseases/recKFKOEWJRQgph7g 1/3 6/24/23, 2:57 PM Rectal foreign body Pathway Obtain contrast-enhanced CT of the abdomen in hemodynamically stable patients with suspected retained anorectal foreign body and a suspected perforation. B Laboratory tests: avoid obtaining routine laboratory tests in patients with suspected retained anorectal foreign body and no signs of bowel perforation. D Show 2 more 2. Diagnostic procedures Sigmoidoscopy: consider performing proctoscopy or flexible sigmoidoscopy after foreign body removal to evaluate bowel wall status in patients with retained anorectal foreign body. C 3. Medical management Antibiotics: Avoid using routine antimicrobials in patients with retained anorectal foreign body. D Administer broad-spectrum antibiotics according to the WSES guidelines on intra-abdominal infections in patients with retained anorectal foreign body and signs of hemodynamic instability or perforation. B 4. Therapeutic procedures Bedside transanal extraction: consider performing bedside extraction as first-line therapy in patients with low-lying retained anorectal foreign body without signs of perforation. C Show 3 more Endoscopic extraction: Consider performing endoscopic extraction as first-line therapy in patients with retained high- lying anorectal foreign body (above rectosigmoid junction). C Avoid performing any maneuver that can disrupt the drug package, including endoscopic retrieval, in patients with retained anorectal foreign body and suspect of drug concealment. D Laparoscopic extraction: consider performing laparoscopic removal, if skills and instrumentation are available, in patients with retained anorectal foreign body and without signs of perforation. C 5. Surgical interventions Surgical extraction (indications): consider performing surgery in patients with retained anorectal foreign body and without signs of perforation, if transanal extraction was failed. C Show 3 more Surgical extraction (closure): consider placing primary suture in patients with retained anorectal foreign body and bowel perforation with limited peritoneal contamination only in case of small and https://web.pathway.md/diseases/recKFKOEWJRQgph7g 2/3 6/24/23, 2:57 PM Rectal foreign body Pathway recent perforation and if the colonic tissues appear healthy and well vascularized, and an approximation of perforation edges could be performed without tension. C Show 2 more References 1. Antonio Tarasconi, Gennaro Perrone, Justin Davies et al. Anorectal emergencies: WSES AAST guidelines. World J Emerg Surg. 2021 Sep 16;16 1 48. Open https://web.pathway.md/diseases/recKFKOEWJRQgph7g 3/3