Prolonged retain period and unsuccessful attempts to remove rectal foreign body by the patient are two important factors that reduce transanal achievement. In our series the success rate of transanal extraction is up to 90 percent. It is related to advantages of operating room and short admission time of our patients. Objects larger than 10cm and those located in the proximal rectum are most likely to require surgical intervention SCH727965 datasheet in literature [10]. In our study proximal rectal localization of foreign bodies were more affected laparatomy requirement. When endoscopic or manual transanal extraction

fails or complications are present, laparatomy is necessary [17–19]. Different operative techniques can also be used for the selleck chemicals llc removal of the foreign body and treatment of the complications.

The decision to perform colostomy to primary rectal suturing only depends on various factors such as intraabdominal contamination, grade of rectal injury, extend of perianal trauma and chronicity of the case. On laparatomy milking the objects towards the rectum or anus enables the surgeon to extract FB without colotomy. Laparascopic asistance can be used in transanal extraction of proximally migrated FB. It allows for easy removal and direct visualization of the rectum to evaluate for injury. Laparascopic primary suturing, resection and diverting colostomy could be realised [20]. After difficult extraction procedure rectal and distal colonic mucosa is have to evaluate with rectosigmoidoscopy that determine extend of injury and exclude possible perforation. In postextraction rectosigmoidoscopy most of

the rectal injuries are in grade I and II as in our series [11]. Surgeons must be aware, in patients with chronicity, of serious anorectal injuries, possibility of perirectal sepcis, and important sequelae such as anal incontinence, fistulas and stenosis in the follow-up Venetoclax chemical structure period [21]. Our clinical algorithm was showed in Figure 3. This treatment guide was developed in the light of our clinical experiences. This sequential management system which we use in our clinical practice of colorectal FB, have helped transanal extraction rate to reach over 90%. Figure 3 Management algorithm of colorectal foreign body. All the patients should be evaluated psychologically. Patients presented with foreign bodies in the rectum should be asked for different sexual behaviours such as homosexuality. Most of the patients reject the abnormal sexual activities. Additionally, the patients should be examined for the use of alcohol and narcotic drugs. 50% of our cases reported high level intake of alcoholic beverages before rectal FB introduction. Conclusions Retained rectal foreign bodies are usually related to improper anal sexual behaviour. Patients should be evaluated with a AZD2014 mouse careful physical and rectal examination and plain radiograms for correct diagnosis and localization.