S4016 Endoscopic Salvage of Colonic Obstruction From an Unidentified Fibrous Foreign Body: A Case Report

Introduction: There are numerous sources of intestinal foreign bodies, including sex toys, produce, and glass among others. Various treatment approaches are required, depending on the composition of the foreign body. In this abstract we present a case of fibrous foreign body obstructing the colon that was removed by a unique technique utilizing a balloon dilator. Case Description/Methods: A 30-year-old woman with no significant past medical history presented with abdominal pain, constipation, nausea and vomiting. Computed tomography (CT) imaging revealed a copious amount of feces within the proximal colon with mucosal thickening resulting in proximal obstruction from a presumed fixed mass in the left colon. Colonoscopy revealed a foreign body completely occluding the lumen of colon in the descending colon. Attempts to remove it with a net were not successful. Surgery was consulted for possible hemicolectomy, but a second colonoscopy was attempted for colon salvage. Attempts for removal involved use of snares, grasping devices, and nets which were unsuccessful. Given approval from the surgery service, we pushed a 20 mm through the scope balloon dilator blindly through the fibrous tissue. The balloon was inflated, and swept towards the colonoscope. The repeated attempts resulted in significant removal of large pieces of fibrous debris. Mineral oil was lavaged through the working channel into the colon to allow for lubrication and to aid in subsequent passage of debris. The patient was given 2 liters of polyethylene glycol and repeated CT showed near resolution of obstruction. Pathology revealed acellular material with inflammatory cells. Discussion: Foreign body ingestions are commonly encountered by gastroenterologists. There are limited tools available to aid in clearance of objects. This case highlights a unique endoscopic intervention using balloon dilation and lavage as an alternative to surgery in the management of colonic obstruction due to foreign body impaction.