Stepwise surgical management of rectal foreign bodies: a multicenter operative case series and systematic review.
4 affiliations
- 1Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
- 2Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- 3Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea.
- 4Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea.
Abstract
Background
Most rectal foreign bodies (RFBs) are removed non-operatively; operative management after failed transanal extraction remains poorly standardized. We describe a multicenter series of surgically managed RFBs and a systematic review of case series to quantify how often abdominal access avoids opening the bowel.Methods
All patients who underwent operating-room extraction of an RFB at three institutions over 5 years (2019-2023) were reviewed; bedside and endoscopy-suite removals were not captured, so the cohort represents surgically managed RFBs. The review (PubMed/MEDLINE, Embase, Scopus, Web of Science; Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020; retrospective registration) included case series of five or more patients in any language, with extracted values checked against primary reports wherever available and source-level qualifications documented explicitly; all included series were appraised item by item with the Joanna Briggs Institute Critical Appraisal Checklist for Case Series.Results
In total, 22 patients (19 men; median age 49 years) were included, all self-inserted. Fourteen were managed transanally or by transanal minimally invasive surgery (TAMIS) (transanal 12, TAMIS 2) and eight by an abdominal approach (five open, two hand-assisted laparoscopic, and one laparoscopic); two minimally invasive attempts were converted. Two proximal objects were delivered per anum by milking without a deliberate bowel incision. Of the other six abdominal cases, three underwent resection, two required deliberate extraction enterotomies that were closed primarily, and one pre-existing contained perforation was managed by lavage and primary repair without diversion; a stoma was formed in three, all with perforation. There were no deaths. Abdominal cases more often involved objects above the rectosigmoid junction (7/8 vs. 2/14) and perforation (4/8 vs. 0/14), but not larger objects; all comparisons were exploratory and unadjusted. The review included 60 series from 26 countries (1976-2026). Among the 42 series that explicitly distinguished milking from bowel opening, 64 of 181 abdominal procedures were completed by milking without an enterotomy. Post-extraction endoscopy was performed in 0%-100% of patients across series.Conclusions
A stepwise, organ-preserving strategy-transanal or TAMIS extraction, then laparoscopic or hand-assisted milking, and then enterotomy, with resection and stoma reserved for perforation with severe injury or contamination-was executable in this cohort. In the published series that record the distinction, abdominal access did not entail opening the bowel in approximately one-third of procedures.
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BibTeX
@article{park2026stepwise,
title = {{Stepwise surgical management of rectal foreign bodies: a multicenter operative case series and systematic review.}},
author = {In Kyu Park and Kyung Uk Jung and Songsoo Yang and Sung Ryol Lee and Joosung Park and Hyung Ook Kim and Hungdai Kim and Jaemin Jo and Joon Young Choi and Sung Yoon Jang and Hongki Gwak and Weon Young Chang and Ho-Kyung Chun and Donghyoun Lee},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1933279},
url = {https://europepmc.org/article/MED/42923243},
note = {CC BY},
}
RIS
TY - JOUR
TI - Stepwise surgical management of rectal foreign bodies: a multicenter operative case series and systematic review.
AU - In Kyu Park
AU - Kyung Uk Jung
AU - Songsoo Yang
AU - Sung Ryol Lee
AU - Joosung Park
AU - Hyung Ook Kim
AU - Hungdai Kim
AU - Jaemin Jo
AU - Joon Young Choi
AU - Sung Yoon Jang
AU - Hongki Gwak
AU - Weon Young Chang
AU - Ho-Kyung Chun
AU - Donghyoun Lee
PY - 2026
DA - 2026/10/08
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1933279
UR - https://europepmc.org/article/MED/42923243
AB - Background Most rectal foreign bodies (RFBs) are removed non-operatively; operative management after failed transanal extraction remains poorly standardized. We describe a multicenter series of surgically managed RFBs and a systematic review of case series to quantify how often abdominal access avoids opening the bowel.Methods All patients who underwent operating-room extraction of an RFB at three institutions over 5 years (2019-2023) were reviewed; bedside and endoscopy-suite removals were not captured, so the cohort represents surgically managed RFBs. The review (PubMed/MEDLINE, Embase, Scopus, Web of Science; Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020; retrospective registration) included case series of five or more patients in any language, with extracted values checked against primary reports wherever available and source-level qualifications documented explicitly; all included series were appraised item by item with the Joanna Briggs Institute Critical Appraisal Checklist for Case Series.Results In total, 22 patients (19 men; median age 49 years) were included, all self-inserted. Fourteen were managed transanally or by transanal minimally invasive surgery (TAMIS) (transanal 12, TAMIS 2) and eight by an abdominal approach (five open, two hand-assisted laparoscopic, and one laparoscopic); two minimally invasive attempts were converted. Two proximal objects were delivered per anum by milking without a deliberate bowel incision. Of the other six abdominal cases, three underwent resection, two required deliberate extraction enterotomies that were closed primarily, and one pre-existing contained perforation was managed by lavage and primary repair without diversion; a stoma was formed in three, all with perforation. There were no deaths. Abdominal cases more often involved objects above the rectosigmoid junction (7/8 vs. 2/14) and perforation (4/8 vs. 0/14), but not larger objects; all comparisons were exploratory and unadjusted. The review included 60 series from 26 countries (1976-2026). Among the 42 series that explicitly distinguished milking from bowel opening, 64 of 181 abdominal procedures were completed by milking without an enterotomy. Post-extraction endoscopy was performed in 0%-100% of patients across series.Conclusions A stepwise, organ-preserving strategy-transanal or TAMIS extraction, then laparoscopic or hand-assisted milking, and then enterotomy, with resection and stoma reserved for perforation with severe injury or contamination-was executable in this cohort. In the published series that record the distinction, abdominal access did not entail opening the bowel in approximately one-third of procedures.
SN - 2296-875X
ER -