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AN EASILY FORGOTTEN TUBE WITH SIGNIFICANT CLINICAL BENEFITS
Raguraj Chandradevan
*, Humberto Sifuentes
Augusta University Medical College of Georgia, Augusta, GA
Introduction:The red rubber rectal tube is a 20-inch device with a funnel end, an open distal tip, and a single side port, widely available in hospital settings but rarely used for colonic decompression. We present three cases where red rubber rectal tubes were effectively used to avoid surgical or invasive procedures, providing a simple yet impactful solution.
Cases:Patient A: A 72-year-old male with recent pneumonia treated with antibiotics presented with watery diarrhea and abdominal distension. CT imaging revealed colon dilation up to 10 cm, with a severely distended sigmoid colon and rectum measuring 12 cm, indicating C. difficile colitis with potential megacolon. He was transferred for a possible colectomy. A rectal exam released trapped gas and liquid stool, and a 30 Fr, 20-inch rectal tube was placed for venting and vancomycin administration. Overnight, 4 liters of liquid stool drained, and his colonic dilation resolved markedly within 48 hours, avoiding the need for colectomy.
Patient B: A 67-year-old male with coronary artery disease and a recent surgery for a bicuspid aortic valve presented with constipation and colonic pseudo-obstruction. CT showed colon dilation up to 11 cm with a dilated rectosigmoid region. Given his bradycardia, neostigmine was contraindicated. A rectal tube was inserted to relieve gas and liquid stool, providing continuous decompression for over 72 hours and successfully, avoiding invasive colonoscopic decompression or colectomy, which posed sedation risks.
Patient C: An 80-year-old male with small intestinal bacterial overgrowth, COPD, and dyssynergic defecation was admitted with fecal impaction and colonic and small bowel ileus. Manual disimpaction was performed, followed by placement of a rectal tube for enema administration, which remained in place for two days to restore bowel function without complications.
Discussion:
These cases underscore the clinical benefits of red rubber rectal tubes as a safe and effective intervention in sigmoid colonic decompression, particularly when invasive procedures carry high risk. Physiologically, red rubber rectal tubes help by reducing outflow resistance, decreasing anorectal angle and sigmoid angulation, and stimulating the anocolonic reflex, facilitating continuous stool and gas drainage under gravity. Placement of these tubes should follow a rectal examination, with digital guidance, and confirmation, that the patient has no coagulopathy. These tubes feature a single opening at the distal tip, are useful for administering rectal enemas and medications. Notably, each patient demonstrated marked clinical improvement without complications, highlighting an effective alternative that is often overlooked. Given the increasing emphasis on minimally invasive interventions, our experience suggests a need for greater awareness and familiarity with red rubber rectal tubes.
Image_1: In patient A: Left side Image A revealed the abdominal X-ray with significant colonic dilatation, with marked distension noted prominently in the sigmoid region and image B revealed status post rectal decompression tube placement, with its tip observed at the level of the T12-L1 intervertebral disc space (The tube marked with red arrows) and interval decompression of the gas-distended colon.
Image_2: Photographic appearance of a red rubber rectal tube.
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