Patient selection: large foreign body in the lower rectum
Premise: The anal sphincter provides a seal around the object. As the object is pulled out this creates a vacuum within the rectum which draws the object back into the rectum.
Method:
(1) Insert a rigid nasogastric tube or Foley catheter into the rectum alongside the object so the tip enters the proximal rectum above the object.
(2) Pump air into the nasogastric tube.
(3) Attempt to remove the object.
(4) As the object is removed pump more air into the rectum.
where:
• The tube should be rigid so that the wall does not collapse when it is between the rectal wall and the object.
• The tip of the catheter should be smooth so that it does not damage the rectal mucosa.
• Lubrication would make the tube pass more easily.
• The amount of air injected is enough to counter the vacuum, not to insufflate the bowel.
When complete the rectum and sigmoid colon should be examined for mucosal injury.
