A middle-aged lady presents to the ED but won’t tell the triage nurse what’s wrong. “I need to see a doctor, is all.” Turns out she has a rectal foreign body. On xray it appears to be an apple. On digital exam you can just feel the bottom of the apple with the distal tip of your middle finger. Next steps?

Get the apple out. There are lots of techniques; here’s one:

1. Consider procedural sedation, anxiolysis and and anal block, in addition to topical lidocaine jelly.

2. Insert two to three double-gloved fingers and grasp the apple periphery; pull it to one side.

3. Insert a foley catheter and have a partner inflate the balloon once the catheter is past the apple.

4. Gently tug on the apple and the foley catheter together. Try for 10-20minutes.

5. If unsuccessful, call surgery. The patient may need to go to the OR.