# Rectal foreign body
A rectal foreign body (RFB) is an object retained in the rectum or distal sigmoid colon that requires medical assistance for removal, most often after self-insertion and failed self-extraction. It is an uncommon surgical emergency, but one that emergency departments and surgical services encounter regularly, and its management follows a broadly stepwise pathway from transanal extraction to abdominal surgery.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full)
| Key fact | Detail |
|---|---|
| Frequency | US emergency-department surveillance recorded an incidence rising from 1.2 to 1.9 per 100,000 between 2012 and 2021; England logged roughly 3,500 hospital episodes of manual removal over 9 years, about one per day.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) |
| Typical patient | Marked male predominance and a bimodal age distribution; in one operative series 19 of 22 patients were men, median age 49 years, and all objects were self-inserted.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) |
| First-line treatment | For low-lying objects without perforation, bedside transanal extraction is suggested as first-line therapy; for objects above the rectosigmoid junction, endoscopic extraction is suggested first (weak recommendations, low-quality evidence, 2C).[2](https://pmc.ncbi.nlm.nih.gov/articles/PMC8447593/) |
| Non-operative success | In one emergency-department cohort, 51.3% of 78 patients requiring removal were successfully treated in the emergency department without reported complications.[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC10750084/) |
| Abdominal surgery rate | Laparotomy has been reported at 8%–10% of cases, with transanal removal in 81.9%–95.5%.[4](https://doi.org/10.4274/tjcd.galenos.2021.2021-12-6) |
| Milking | Among 42 published series that distinguished milking from bowel opening, 64 of 181 abdominal procedures (about one-third) were completed by milking the object distally without an enterotomy.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) |
| Complications | A systematic review and meta-analysis reported a total complication rate of 30.4%.[5](https://pubmed.ncbi.nlm.nih.gov/32233273/) |
## Epidemiology and presentation
Retained rectal foreign bodies are described in the surgical literature going back centuries, and case series have accumulated since at least the 1970s; a 1976 report of 28 patients was described at the time as the largest published series.[6](https://pmc.ncbi.nlm.nih.gov/articles/PMC1345490/) Reported cohorts consistently show a marked male predominance and a bimodal age distribution.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) Objects are diverse: bottles and glasses, aerosol and cosmetic containers, sexual devices, vegetables, and wooden or metallic handles appear in operative series, with median longest dimensions around 17 cm.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) A Japanese series of 20 cases treated between 2008 and 2024 included sex toys (8 cases), bottles and cans (5), and food items (2), with a median age of 60 years and 18 of 20 patients male.[7](https://www.jstage.jst.go.jp/article/jcoloproctology/79/1/79_8/_article/-char/en)
**Delayed presentation is characteristic.** [Embarrassment](https://www.edgepedia.org/embarrassment) leads many patients to attempt self-extraction before seeking care, and presentation is frequently delayed as a result.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) In the three-center operative series, the median time from insertion to presentation was 8 hours, with a range of 0.5 to 36 hours.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) The chief complaint in the Japanese series was difficulty removing the foreign body in 17 of 20 cases.[7](https://www.jstage.jst.go.jp/article/jcoloproctology/79/1/79_8/_article/-char/en)
## Diagnosis and assessment
The key initial assessments are the object's location and the presence of perforation. Location is commonly dichotomized at the rectosigmoid junction: low-lying objects in the rectal ampulla are usually palpable on digital rectal examination, while high-lying objects are not.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) • [8](https://www.gcs16.com/uploads/1/7/9/2/17925143/gi_fb.pdf) Plain radiographs are used to localize the object and to rule out pneumoperitoneum from perforation; CT is reserved for suspected high-lying objects or possible perforation.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) • [9](https://wjes.biomedcentral.com/counter/pdf/10.1186/1749-7922-8-25) In the operative series, free air on imaging was present in four of 22 patients (18.2%) and corresponded exactly to the four perforations confirmed at operation.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full)
## Management
**Stepwise, organ-preserving extraction.** The stepwise principle, transanal extraction whenever possible and abdominal intervention as a last resort, was articulated as early as 1977 and restated across five decades of series and consensus documents.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) The WSES-AAST guidelines suggest bedside extraction as first-line for low-lying retained objects without signs of perforation, and pudendal nerve block, spinal anesthesia, intravenous conscious sedation, or general anesthesia to improve retrieval chances after bedside failure; for high-lying objects above the rectosigmoid junction, endoscopic extraction is suggested first. Surgery is suggested after failed transanal extraction in patients without perforation. No recommendation distinguishes one transanal technique over another.[2](https://pmc.ncbi.nlm.nih.gov/articles/PMC8447593/)
A range of transanal techniques is described beyond manual removal: forceps or a Kocher clamp, polypectomy snares, an inflated [Foley catheter](https://www.edgepedia.org/foley-catheter), a vacuum extractor, and endoscopic dilatation balloons.[4](https://doi.org/10.4274/tjcd.galenos.2021.2021-12-6) In a large Chinese series of 291 cases, 94% of patients in the swallowed-object group underwent a transanal surgical procedure, and all were successful.[10](https://pubmed.ncbi.nlm.nih.gov/36057731/) [Examination under anesthesia](https://www.edgepedia.org/examination-under-anesthesia) with maximal dilation achieved a 75% success rate in one case series.[11](https://www.ijsurgery.com/index.php/isj/article/download/10355/6207/47581)
**Transanal minimally invasive surgery (TAMIS)** uses a sealed transanal platform with insufflation and instrument triangulation, allowing extraction of objects that are palpable but beyond the reach of a finger or forceps, without abdominal access.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) Insufflation can also distend the colonic walls and break the vacuum effect that impedes removal of smooth containers.[11](https://www.ijsurgery.com/index.php/isj/article/download/10355/6207/47581)
**Abdominal approaches.** When transanal extraction fails, laparoscopy or hand-assisted laparoscopy allows manual milking of the object distally for transanal delivery without a deliberate bowel incision; extraction enterotomy is used only when milking fails, and resection or fecal diversion is reserved for perforation with severe bowel-wall injury, peritoneal contamination, or non-viable bowel.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) In the three-center series of 22 operative patients, 14 were managed transanally or by TAMIS and 8 by an abdominal approach (five open, two hand-assisted laparoscopic, one laparoscopic). Two proximal objects were delivered per anum by milking; of the other six abdominal cases, three underwent resection, two required enterotomies closed primarily, and one contained perforation was managed by lavage and primary repair without diversion. A stoma was formed in three patients, all with perforation, and there were no deaths.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full)
## What determines the route
Object location, not size, separates the operative routes. In the 22-patient series, abdominal cases more often involved objects above the rectosigmoid junction (7 of 8 versus 2 of 14) and perforation (4 of 8 versus 0 of 14), while object dimensions did not differ between groups. Patients treated abdominally were older (median 57 versus 40 years) and stayed longer (median 9 versus 1.5 days). These comparisons were exploratory and unadjusted, since location and perforation themselves contributed to the approach selected.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) Case observations and prior reports suggest that shape and consistency also matter, for example glass objects are considered a potential laparotomy indication because manipulation during transanal extraction can break the glass in the rectum, but this was not formally tested.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) • [12](https://pmc.ncbi.nlm.nih.gov/articles/PMC7714380/)
## Post-extraction assessment and outcomes
Practice after extraction varies widely. Post-extraction endoscopy was performed in every patient in several published series and in none in others, with intermediate rates including 79%, 76%, 45.5%, 22.7%, and 7%. Where diagnostic yield was reported, injury was identified in 20% to 100% of patients examined, depending on the series; in the operative series, mucosal lacerations were found in 6 of 10 examined patients, with the submucosa intact in every case and no injury altering management.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full)
**Functional outcomes are rarely measured.** In the operative series, digital assessment on postoperative days 1 and 3 recorded preserved resting and squeeze tone in all patients, and transient incontinence to liquid stool was reported by three patients (13.6%), all after manual transanal extraction, resolving within 2 months.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) The near-absence of functional follow-up in the literature has a documented structural cause: patients characteristically decline follow-up, and the few series that obtained outcomes report preserved continence.[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full) Recurrence prevention may require psychiatric intervention in cases of habitual insertion.[7](https://www.jstage.jst.go.jp/article/jcoloproctology/79/1/79_8/_article/-char/en)
## References
1. [Park IK, et al. Stepwise surgical management of rectal foreign bodies: a multicenter operative case series and systematic review. Frontiers in Surgery, 2026.](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1933279/full)
2. [Tarasconi A, et al. Anorectal emergencies: WSES-AAST guidelines. World Journal of Emergency Surgery, 2021.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8447593/)
3. [Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis. 2023.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10750084/)
4. [Süleyman et al. Turkish Journal of Colorectal Disease, 2021.](https://doi.org/10.4274/tjcd.galenos.2021.2021-12-6)
5. [Foreign rectal body: Systematic review and meta-analysis. 2020.](https://pubmed.ncbi.nlm.nih.gov/32233273/)
6. [Barone JE, Sohn N, Nealon TF. Perforations and foreign bodies of the rectum: report of 28 cases. Annals of Surgery, 1976.](https://pmc.ncbi.nlm.nih.gov/articles/PMC1345490/)
7. [Ando S, Tsutsuyama M, Mashita N. Management of Transanal Rectal Foreign Bodies: A Review of 20 Cases. Journal of the Japan Society of Coloproctology, 2026.](https://www.jstage.jst.go.jp/article/jcoloproctology/79/1/79_8/_article/-char/en)
8. [Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies.](https://www.gcs16.com/uploads/1/7/9/2/17925143/gi_fb.pdf)
9. [Yildiz et al. World Journal of Emergency Surgery, 2013.](https://wjes.biomedcentral.com/counter/pdf/10.1186/1749-7922-8-25)
10. [A retrospective analysis of transanal surgical management of 291 cases with rectal foreign bodies. 2022.](https://pubmed.ncbi.nlm.nih.gov/36057731/)
11. [Better out than in: a case series of retained rectal foreign bodies. International Surgery Journal, 2024.](https://www.ijsurgery.com/index.php/isj/article/download/10355/6207/47581)
12. [The Management of Retained Rectal Foreign Body. 2020.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7714380/)
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*Topic: Encyclopedia › Life and health › Human health and medicine › Diseases and injuries › Digestive, metabolic, and endocrine conditions › Gastrointestinal disease › Intestinal and anorectal disorders*
*Initially written Sep 17, 2026 · Reviewed: Sep 30, 2026; Oct 21, 2026 · Edited: Oct 15, 2026; Oct 21, 2026 · Last review: Oct 21, 2026*
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