The study comprised 291 RFB in-hospital cases, including 225 (77.3%) males and 66 (22.7%) females with a mean age of 53.8 ± 15.5 years (range, 1ཞ88 years). According to the source of the RFB entering the body, we divided the patients into 3 groups: the swallowed group (199 cases, 68.4%), the self-inserted group (87, 29.9%), and the iatrogenic group (5, 1.7%). The swallowed group had a mean age of 55.2 years (range, 1ཞ88y), and 134 (67.3%) were male. The self-inserted group had a mean age of 50.6 years (range, 12ཞ85y), and 85 (97.7%) were male. The iatrogenic group had a mean age of 56.5 years (range, 51ཞ63y), and 2 (40%) were male. The proportion of male patients in the self-inserted group was significantly higher compared to the swallowed RFB group (t = 31.114, p = 0.000; Table 1.)
Table 1
Demographics of three RFB groups
| Swallowed | Self-inserted | Iatrogenic | Totals |
Cases | 199 (68.4%) | 87 (29.9%) | 5 (1.7%) | 291 |
Age | 55.2 ± 15.9 | 50.6 ± 14.8 | 56.6 ± 5.5 | 53.8 ± 15.5 |
Gender (Male/Female) | 134/65 (67.3%/32.7%) | 85/2 (97.7%/2.3%) | 2/3 (40%/60%) | 225/66 (77.3%/22.7%) |
We further classified the RFB of the three groups. In the swallowed group, jujube nuclei were the most common objects (167, 83.9%). Other swallowed foreign objects were as follows (n, %): fishbone (14, 7.0%), bone (9, 4.5%), toothpick (4, 2.0%), and others (shell, denture, food package, 5 cases, 2.5%). In the self-inserted group, the classification was as follows (n, %): bottle (17, 19.5%), hard stick or tube (15, 17.2%), sausage or soft sausage-shaped object (12, 13.8%), masturbator (12, 13.8%), pen (7, 8.0%), self-use medical device or component (6, 6.9%), sphere (6, 6.9%), bottle cap (5, 5.7%), cup (5, 5.7%) and others (2, 2.3%). The iatrogenic RFB group consisted of 4 cases (80%) of PPH staples and 1 case (20%) of a uterine contraceptive device(Table 2).
Table 2
| Swallowed | Self-inserted | Iatrogenic |
| n = 199 | n = 87 | n = 5 |
Category of RFB n (%) | Jujube nuclei | 167 (83.9%) | Bottle | 17 (19.5%) | PPH staples | 4 (80%) |
| Fishbone | 14 (7.0%) | Stick or tube (hard) | 15 (17.2%) | Intrauterine device | 1 (20%) |
| Bone | 9 (4.5%) | Sausage or sausage type(soft) | 12 (13.8%) | | |
| Toothpick | 4 (2.0%) | Masturbator | 12 (13.8%) | | |
| Other (shell, denture, food package) | 5 (2.5%) | Pen | 7 (8.0%) | | |
| | | Self-use medical device or component | 6 (6.9%) | | |
| | | Sphere | 6 (6.9%) | | |
| | | Bottle cap | 5 (5.7%) | | |
| | | Cup | 5 (5.7%) | | |
| | | Other | 2 (2.3%) | | |
The anorectal injures and pathological changes caused by the RFB and its location were classified according to the description in the medical records. In the swallowed group, the most common anorectal injuries and pathological changes were the following (n cases, %): penetration of the mucosa (75, 37.7%), perianal or submucosal abscess (27, 13.6%), and penetration of the anal canal (18, 9.04%). In addition, there were four important but less common injuries or pathological changes (n cases, %): rectal mucosal rupture (6, 3.0%), congestion and edema of rectal mucosa (3, 1.5%), internal hemorrhoid bleeding (2, 1.0%), and rectal bleeding (1, 0.5%). Notably, 2 patients suffered from perianal abscess 5 and 7 days following RFB removal. There were 67 cases in this group that had no injuries or pathological changes described in the medical records. In the self-inserted group, we found that most cases did not have rectal or anal injures, with 64(73.6%)of the 87 cases having an intact rectum. However, 8 cases (9.2%) had rectal mucosal ulcers and bleeding, 7 (8%) had rectal lacerations, 4༈4.6%༉had congestion and edema of the rectal mucosa, and there was 1 case each (1.1%) of skin laceration of the anal canal, internal hemorrhoid bleeding, rectal mucosal necrosis, and perianal abscess. In the iatrogenic group, 3 cases (60%) had rectal mucosal ulcers and bleeding, and the other 2 cases (40%) had inflammation of the rectal mucosa (Table 3).
The location of the rectal foreign body was confirmed by digital rectal examination, X-ray, and anoscopy. Approximately one-half of the swallowed RFB were located at the junction of the rectum and anal canal (100 cases, 50.3%). In 27 swallowed cases (13.6%), the foreign body had penetrated into the rectal mucosa or skin of the anal canal. In 11 cases (5.6%), the RFB were movable within the rectal cavity, and in 2 cases (1%), the RFB had entered an abscess cavity. In the self-inserted group, the RFB of 54 cases (62.1%) were in the rectal cavity. The RFB of the remaining 33 cases (37.9%) were in both the rectum and sigmoid colon. In 4 cases (80%) of the iatrogenic RFB group, hemorrhoidectomy PPH staples were left in the rectal wall. In the other iatrogenic case (20%), CT confirmed that an intrauterine device had punctured into the rectum through its anterior wall (Table 3).
Table 3
Anorectal injuries and pathological changes
| Swallowed (199) | Self-inserted (87) | Iatrogenic (5) |
Anorectal injuries and pathological changes | penetration into mucosa | 75 (37.7%) | rectal mucosal ulcer and bleeding | 8 (9.2%) | rectal mucosal ulcer and bleeding | 3 (60%) |
perianal and submucosal abscess | 27 (13.6%) | rectal laceration | 7 (8.0%) | inflammation rectal mucosa | 2 (40%) |
penetration into anal canal | 18 (9.04%) | congestion and edema of rectal mucosa | 4 (4.6%) | | |
small rectal mucosa rupture | 6 (3.0%) | skin laceration of anal canal | 1 (1.1%) | | |
congestion, edema of rectal mucosa | 3 (1.5%) | internal hemorrhoid bleeding | 1 (1.1%) | | |
internal hemorrhoid bleeding | 2 (1.0%) | rectal mucosal necrosis | 1 (1.1%) | | |
rectal bleeding | 1 (0.5%) | perianal abscess | 1 (1.1%) | | |
delayed perianal abscess | 2 (1.0%) | | | | |
Total | 132 (66.3%) | Total | 23 (26.4%) | Total | 5 (100%) |
no injuries or pathological changes, not described | 67 (33.7%) | no injuries or pathological changes, not described | 64 (73.6%) | | |
Location of RFB | Stuck, junction of rectal and anal canal | 100 (50.3%) | in rectal cavity | 54 (62.1%) | in rectal wall | 4 (80%) |
penetration rectal mucosa | 27 (13.6%) | in lumen of sigmoid colon | 33 (37.9%) | penetrated rectum | 1 (20%) |
penetration skin of anal canal | 27 (13.6%) | | | | |
free in rectal cavity | 11 (5.6%) | | | | |
in abscess cavity | 2 (1%) | | | | |
not described | 32 (16.1%) | | | | |
In the swallowed group, 187 (187/199, 94%) patients had resolution by the transanal surgical procedure; in 10 (5%) patients the RFB was expelled prior to the planned procedure. All the transanal surgical procedures were successful in this group. Of the 187 patients treated by the transanal surgical procedure, the anesthetic techniques used were (n cases, %): sacral, 144 (77%); local, 39 (20.9%); general, 3 (1.6%); and no anesthesia in 1 (0.5%). In conjunction with RFB extraction in this group, 27 patients underwent perianal abscess incision and drainage, 16 patients underwent debridement, and 6 patients underwent wound suture.
In the self-inserted group, 82 patients underwent the transanal surgical procedure with successful removal in 74 (90.2%), whereas in 8 (9.8%) the operation was unsuccessful. The anesthetic techniques used in this group were (n cases, %): sacral, 75 (91.5%); local, 5 (6.1%); and no anesthesia in 2 (2.4%). In conjunction with extraction of the RFB, 4 (4.9%) required suture of rectal injures, 3 (3.7%) necessitated partial sphincterotomy due to the excessive foreign body size, and 1 (1.2%) underwent perianal abscess incision and drainage. In the iatrogenic group, 3 (75%) had resolution with the transanal procedure under sacral anesthesia, whereas 1(25%) failed (Table 4).
Table 4
| Swallowed (199) | Self-inserted (87) | Iatrogenic (5) |
Outcomes | Transanal removal | 187 (94%) | Transanal removal | 74 (85.1%) | Transanal removal | 3 (60%) |
| Spontaneous discharge | 10 (5%) | Failed transanal removal | 8 (9.2%) | Failed transanal removal | 1 (20%) |
| Untreated, left to pass | 2 (1%) | Transfer to other hospital | 2 (2.3%) | Transfer to other hospital | 1 (20%) |
| | | Untreated, left to pass | 3 (3.4%) | | |
Success, transanal procedure | 187/187 | 100% | 74/82 | 90.2% | 3/4 | 75% |
Anesthesia Method | General anesthesia | 3 (1.6%) | Sacral anesthesia | 75 (91.5%) | Sacral anesthesia | 4 (100%) |
| Sacral anesthesia | 144 (77%) | Local anesthesia | 5 (6.1%) | | |
| Local anesthesia | 39 (20.9%) | Not anesthetized | 2 (2.4%) | | |
| Not anesthetized | 1 (0.5%) | | | | |
Other surgical procedures | Abscess incision and drainage | 27 | Rectal injury suture | 4 | | |
| Debridement | 16 | Partially severed sphincter | 3 | | |
| Suture to stop bleeding | 6 | Perianal abscess incision and drainage | 1 | | |