Endoscopic salvage of colonic obstruction caused by an unidentified fibrous foreign body

Authors

• Mohammed Y. Youssef Internal Medicine Department, Arkansas Colleges of Health Education, Fort Smith, USA
• Isabella Bortolussi Internal Medicine Department, Arkansas Colleges of Health Education, Fort Smith, USA
• Mohamed H. Eldessouki Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, USA
• Hafsa Khan Internal Medicine Department, Arkansas Colleges of Health Education, Fort Smith, USA
• Asim Usman Internal Medicine Department, Arkansas Colleges of Health Education, Fort Smith, USA
• Jaison John Internal Medicine Department, Arkansas Colleges of Health Education, Fort Smith, USA

mohammedyoussef96@yahoo.com

Keywords

Abstract

Introduction: There is a large variety of intestinal foreign bodies, including sex toys, produce, and glass, and management depends on the object’s composition and location. We present a case of a fibrous foreign body causing complete colonic obstruction that was successfully treated using a novel balloon-assisted technique.
Case description: A 30-year-old woman with no significant medical history presented with abdominal pain, constipation, nausea, and vomiting. Computed tomography (CT) imaging demonstrated a large faecal burden in the proximal colon with mucosal thickening and obstruction from a presumed fixed mass in the left colon. Colonoscopy revealed a foreign body completely occluding the descending colon lumen. Initial removal attempts using nets, snares, and grasping devices were unsuccessful, and surgery was consulted for possible hemicolectomy. In a final effort to avoid surgery, a 20 mm through-the-scope balloon dilator was advanced blindly through the fibrous obstruction. The balloon was inflated and retracted toward the colonoscope to fragment and sweep debris. Repeated passes removed substantial fibrous material. Mineral oil lavage was administered to lubricate the lumen and facilitate debris passage. The patient subsequently received 2 litres of polyethylene glycol. Repeat CT imaging showed near-complete resolution of obstruction. Pathology demonstrated acellular fibrous material with inflammatory cells.
Discussion: Foreign body ingestion is common, yet refractory colonic impactions lack standardized management. This case demonstrates that balloon-assisted sweeping with adjunctive lavage can provide a safe, surgery-sparing alternative for complex colonic foreign body obstruction.

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