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ENDOSCOPIC-ASSISTED RECTAL FOREIGN BODY EXTRACTION USING SURGICAL INSTRUMENTS
Mohamed S. Naguib³, Ahmed M. Ali³, Hazem Abosheaishaa^*1,2
1Icahn School of Medicine at Mount Sinai, New York, NY; ²GI Research Club, American Society for Inclusion, Diversity and Equity in Health Care, Lewes, DE; ³Cairo University Kasr Alainy Faculty of Medicine, Cairo, Cairo Governorate, Egypt

INTRODUCTION
Rectal foreign body (RFB) insertion is a rare but increasingly reported condition, often requiring multidisciplinary management. While smaller and easily accessible objects can be managed with manual or standard endoscopic techniques, larger or embedded objects pose significant challenges, including risk of perforation or mucosal injury. This study highlights two cases where endoscopic-assisted techniques combined with surgical instruments facilitated successful extraction of RFBs.
METHODS
Two patients with RFBs presented to the gastroenterology service at a tertiary care center between 2018 and 2023. Both underwent comprehensive evaluation, including clinical assessment, imaging, and tailored extraction procedures using a combination of endoscopic and surgical tools under sedation.
RESULTS
Case 1: A 27-year-old male presented to the emergency department with a plastic spray bottle cap impacted in the rectum. Clinical evaluation revealed stable vital signs and no evidence of peritonitis. A plain abdominal X-ray confirmed a large, oval-shaped foreign body in the rectum with no signs of perforation. Manual extraction attempts were unsuccessful due to the object’s smooth surface and location in the mid-rectum. Flexible endoscopy revealed the tightly embedded cap, which could not be removed with standard endoscopic tools. Under direct endoscopic visualization, specialized tenaculum forceps were introduced, allowing secure grasping of the object. By applying controlled traction while monitoring mucosal integrity, the foreign body was successfully dislodged and extracted without injury. The patient was discharged the next day without complications.
Case 2: A 50-year-old male with a history of rectosigmoid cancer and anastomotic resection presented with an embedded metallic stent causing chronic rectal irritation. The stent had been placed previously for a tight stricture but became embedded over 1.5 years, and the patient developed symptoms refractory to medical management. Conventional endoscopic extraction attempts were unsuccessful due to the tight embedding of the stent below the anastomotic site. Under deep sedation, endoscopic-assisted extraction was performed using surgical forceps to carefully grasp and manipulate the stent. Gradual and controlled tension allowed for safe dislodgment and removal of the stent. The patient tolerated the procedure well and was discharged 24 hours later with symptom resolution.
CONCLUSIONS
Endoscopic-assisted extraction with surgical instruments is a safe and effective approach for managing complex RFB cases. These techniques leverage the strengths of endoscopy while incorporating specialized tools to address challenging scenarios. This case series underscores the importance of a multidisciplinary and minimally invasive approach to optimize outcomes for patients with rectal foreign bodies


Foreign body at the rectum

Using surgical foreceps to remove the embedded foreign body

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