Endoscopy also provides excellent visualization of the mucosa to evaluate for subtle and gross changes in the rectal mucosa. Endoscopy can serve as a middle ground in many cases to avoid surgical exploration by enabling evaluation and therapeutic removal of objects that may have been nonamenable to transanal extraction. Once successful extraction has been accomplished, the endoscope should be passed again to evaluate the bowel mucosa for any inadvertent injuries.

If the local perianal block and sedation are unsuccessful in the emergency department, the patient needs to be brought to the operating room for a general or spinal anesthetic to aid in the removal of the object. After anesthesia has been applied and the patient is adequately

relaxed, if the foreign body cannot be removed from below then a click here laparotomy is indicated [3, 4]. Surgery is also indicated in all patients who present with perforation (free air), sepsis, or peritonitis. Some surgeons have also described laparoscopy as an aid to push the object more distally into the rectum for a transanal removal. The first step is to attempt to milk the object distally into the rectum. If this fails, then a colotomy and removal of the foreign object is needed. This colotomy can be primarily repaired. Diversion is reserved for patients with frank peritonitis and instability, perforation with extensive fecal contamination [3, 4]. The XL765 molecular weight most dangerous complication of a rectal foreign body is perforation. When patients present with a rectal perforation, they should at first be stabilized like any trauma patient. After stabilization, management depends on 3 factors: first, whether the patient is clinically stable or unstable, second, whether the perforation is in an intraperitoneal or extraperitoneal location, and last, whether there is significant fecal soilage or not. A good rule of thumb is to manage a rectal perforation from a foreign body are diversion, pentoxifylline debridement, distal washout, and drainage. Unstable patients, those with multiple comorbidities, and those with significant tissue damage and de-layed presentation more often require a

diversion. On the other hand, patients who present early after the insult, those with minimal tissue damage, and those with little to no contamination can be managed with primary repair and washout. Small extraperitoneal injuries can also be managed with observation, avoidance of oral feeding, and antibiotics. However laparoscopic approach has been successfully aplied in the treatment of colonic perforations, where equivalent operative outcomes as open procedures can be accomplished in selected patients [11]. Postremoval observation depends on several factors, such as the clinical status of the patient, comorbidities, delay in presentation, and whether or not there was any resultant trauma to the rectum or surrounding tissue. Postextraction endoscopy and plain radiographs are a must before discharging any patient who had a foreign body removal [3–5].