A rectal pack is often indicated after certain surgical procedures and should provide for hemostasis, but it should also indicate persistent bleeding. Most packs are either too bulky, causing increased postoperative pain, or they completely occlude the rectum.
First introduced to me by Isadore S. Ravdin, MD, the "whistle tube" rectal pack has been a useful adjunct in many postoperative rectal procedures, especially after hemorrhoidectomy. As indicated in the Figure, one non-radiopaque sponge is wrapped around a large-gauge, stiff, rubber catheter usually 28 F or 30 F. The sponge is tied on firmly with 0 silk and may be sutured through the catheter. The end of the catheter with multiple holes is inserted into the rectum so that it extends about 5 cm above the operative site. The sponge is greased with an anesthetic jelly, such as lidocaine, for postoperative comfort. Excess catheter is then cut off and incorporated into
Saik RP. An Improved Rectal Pack. Arch Surg. 1976;111(12):1406. doi:10.1001/archsurg.1976.01360300096017