CORPAL RECTUM

BY: GHANA HENDRA G.M.

KO A S B E D A H R S U G M 2 0 1 7
Identitas Pasien
Nama : Bp ES
Usia : 48 th
Jenis kelamin : Laki- laki
Alamat : Jln. Kyai Muntang No 54
No RM : 0769xx
Bangsal : GK 3
Tanggal masuk : 12-3-2017
Anamnesis
Keluhan Utama : Nyeri pada anus
RPS :
◦ 7HSMRS Pasien mengeluhkan nyeri pada anus. Nyeri yang dirasakan mendadak, tanpa ada pencetus,
dan disertai darah yang keluar dari anus. Pasien juga mengeluhkan tidak dapat BAB dan BAK, kemudian
pergi ke klinik langsung dipasang kateter.
◦ 3HSMRS  Pasien berobat ke RS PKU wonosobo kemudian dilakukan rontgen , hasilnya terdapat benda
tabung pada rectosigmoid. Di sana sudah coba diambil di kamar operasi namun hanya bisa diambil
sebagian
◦ HMRS  pasien dirujuk ke RS UGM, keluhan tdk bisa BAB (+), flatus (+), nyeri pada anus (+), darah yang
keluar dari anus (-), nyeri perut (-), perut terasa penuh (+), demam (-), penurunan berat badan (-), riw
trauma pada anus (-)
Riwayat Penyakit Dahulu
Riw operasi telah dilakukan operasi evakuasi corpal di RS sebelumnya, namun tidak
berhasil
Riw kanker (-)
Riw alergi (-)
Riw DM (-)
Riw Hypertensi (-)
Riw peny jantung (-)
Riwayat Pribadi
Pasien menyangkal ketika ditanya mengenai riwayat memasukkan sesuatu pada anus
Pasien tidak kooperatif ketika ditanya mengenai riwayat perilaku seksualnya
Pasien merupakan pekerja lepas teknisi elektronik, pasien sudah berkeluarga, dan sudah
memiliki satu anak. Istri pasien bekerja sebagai TKW di hongkong dan hanya bertemu beberapa
kali dalam satu tahun. Pasien tinggal sendiri di rumah.
Riwayat Penyakit Keluarga
Riw operasi (-)
Riw kanker (-)
Riw alergi (-)
Riw DM (-)
Riw Hypertensi (-)
Riw peny jantung (-)
Pemeriksaan fisik
Keadaan umum : cukup
Kesadaran : Compos Mentis
Vital sign :
◦ Tekanan darah : 110/70 mmhg
◦ Suhu : 36 C
◦ Nadi : 65 x / menit
◦ Pernafasan : 20 x / menit
◦ Skala nyeri : 4 / 10
Kepala : CA -/-, SI -/-
Leher : Lnn tak teraba, JVP tidak meningkat
Paru : simetris, sonor, SDV +/+, rhonki -/-, wheezing -/-
Cor : S1-S2 reguler, bising -, cardiomegaly -
Abdomen :
◦ Inspeksi : dinding perut // dinding dada, darm contour -, darm steifung –
Auskultasi : Peristaltik 20x/menit, metalic sound -, borborygmi–
◦ Perkusi : timpani pada 13 titik
◦ Palpasi : hepatomegali (-), splenomegali (-), nyeri tekan (-), defend muscular (-),
teraba massa(-)

ekstremitas : akral hangat, CRT <2 seconds, nadi kuat

Status lokalis :
◦ Inspeksi pada daerah anus : darah -, massa -, luka -, kemerahan –
◦ Rectal toucher : TMSA longgar, ampula tdk teraba, teraba massa berbentuk tabung,
dengan diameter 8 cm, ujung tabung teraba mulai 2 cm dari anal verge, pangkal tabung tdk bisa diraih
Pemeriksaan Penunjang
Darah Rutin
Hb: 15,3 g/dL
AL: 20.290 / mm3
AT: 182.000 / mm3
AE: 5,1 x 106/ mm3
HCT: 43,8%
HbSAg: non reaktif
Pemeriksaan Radiologi
Diagnosis
Corpal rectum
Plan
Evakuasi corpal rectum
Durante evakuasi corpal
durante evakuasi corpal
ANATOMY
 CORPAL/FOREIGN BODY

DEFINITION : In the field of medicine, a foreign body, sometimes known as FB (Latin: corpus
alienum), is any object in the body of organism that originating outside the body of an organism
Some examples of corpal in rectum
Etiology
1.Erotic activity: usually vibrator, bottle, light bulb, candle, and any other objects
2.Concealment : criminals & psychiatric
3. Older patient: prostate massage and break up fecal impaction
4. Swallowed by mouth ;usually popcorn, toothpick, sunflower seed
5. Child Abuse; usually blunt object
Classification of rectal foreign body
Relative to rectosigmoid junction
1. High-lying
High lying
◦ above the sacral curve and rectosigmoid junction Low lying
◦ difficult to visualize and remove
◦ unreachable with rigid proctosigmoidoscopy.
2. Low –lying
◦ Below the rectosigmoid junction
◦ palpable on digital examination
◦ candidates for ED removal.
EPIDEMIOLOGY
• No reliable data on the frequency of rectal foreign bodies
•It is likely that the use of various objects for anal eroticism = incidence of retained
rectal foreign bodies
•The age distribution is bimodal, with peaks in the 20s (eroticism) and 60s (prostatic
massage)
•higher in males than in females: approximately 28:1
PRESENTATIONS
History :
◦ Patients are usually aware and often present requesting removal

◦ rectal pain or bleeding, pain with defecation, and, less often, abdominal pain

◦ May be too embarrassed to mention the foreign body but usually admit the etiology

◦ Ask for any instrumentation on FB; increases the risk of perforation or laceration

◦ The type of object -> fragile or sharp foreign bodies deserve special consideration.

◦ should be asked if it’s the result of assault ; serious injury is more likely
PRESENTATIONS
Physical exam :
◦ Fever or hypotension -> infection or bleeding

◦ Absent bowel sounds, rigidity, or peritoneal signs -> perforation

◦ Check for the presence of blood and the position of the foreign body with rectal toucher ; low lying can be palpated

◦ Rectal toucher should be deferred, especially in prisoners or psychiatric patients, until the location and
type of foreign body has been ascertained radiographically

◦ dangerous objects such as guns or sharp objects (eg, needles, razor blades) are inserted rectally to hide the
object or, to injure the examiner.
 WORKUP
1. Laboratory studies
• Not add much useful in the acute presentation.
• hematocrit useful if bleeding is present.
• WBC count with differential  in infection suspicion.
• operative candidates routine preoperative laboratory studies.
2. Radiography
• flat plate radiograph abdomen or pelvis  identify and localize
• lateral pelvic film  add information whether it’s high- or low-lying.
• upright chest radiograph  if perforation is suspected.
• Computed tomography  if perforation or abscess
TREATMENT
Approach consideration :
◦ Adequate analgesia and direct
visualization are critical to success.
Patient relaxation is key.
◦ hypotension caused by sepsis or
hemorrhage  Fluid resuscitation
◦ If the patient is cooperative, manual
transabdominal attempt to
manipulate the foreign body into a
low-lying  ED extraction can
be attempted.
 TREATMENT - extractions
. •Adequate sedation ( mild sedative : midazolam)
•Analgesia ( morphine, hydromorphine, fentanyl)
•Insert lubricated anoscope/ proctoscope
Establish direct •Direct lighting
visualization •If cannot be visualized, apply gentle pressure on the lower abdomen  move the foreign body into the field of vision

•Grasp visualized FB with forceps, snares, or retractors

•Withdraw it
•If cannot be removed within 20-30 minutes. , consult a surgeon or a gastroenterologist.
Evacuating FB

•carefully reexamine the rectum through the anoscope or proctoscope to detect any bleeding or tearing or to identify any additional foreign bodies.
•The sphincters should be assessed  continence
•Discharge patients on oral analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotic medications, as indicated. Antibiotics generally are not indicated in patients
evaluation discharged home from the ED.
Evacuation illustration
Anoscope/ speculum
TREATMENT – extractions cont.
Other extraction techniques that
have been described include
balloon extraction, in which
a pneumatic dilation balloon is
inserted distal to the foreign
body, inflated, and then
withdrawn, pulling the foreign
body out along with the inflated
balloon.
COMPLICATIONS
Delays in presentation and multiple attempts at self-removal lead to

• Mucosal edema and muscular spasmshinder removal.

• Rectal lacerations and perforations

• infection with abscesses and sepsis.

All cases of suspected laceration or perforation should be treated by administering a broad-

spectrum antibiotic such as piperacillin-tazobactam.
 MEDICATION
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Agents used in patients with rectal foreign bodies :
1. Narcotic analgesics: Narcotic analgesics facilitate the visualization and successful removal of the
foreign body.
2. Benzodiazepines: facilitate visualization and successful removal of the foreign body.
3. Antibiotics: Empiric antimicrobial therapy must be comprehensive and should cover all likely
pathogens
PROGNOSIS
Majority prognosis is excellent.
For foreign bodies that result in perforation of the rectal or colon wall good with the use of antibiotics
and operative intervention
Deaths  rare and are almost always the result of perforation with prolonged delay until presentation
for care.
Mortality is rare and results from bleeding, rectal perforation or laceration, and infectious
complications.
Morbidity is somewhat more common and is primarily the result of rectal laceration or perforation.