Endoscopic retrieval of a fragile foam foreign body at the rectosigmoid junction using an improvised lithotripter-guidewire retrieval device

Rectal foreign bodies are most often voluntarily inserted for sexual stimulation, primarily in men.[ 1​ ] [ ​2​ ] Although various extraction techniques are used clinically,[ 3​ ] [ ​4​ ] conventional methods sometimes fail with objects of specific characteristics. In this report, we present a case of successful endoscopic retrieval of a rectal foreign body using a simple homemade device constructed from a lithotripter outer sheath and a guidewire ([ Video 1 ]). Video 1 Endoscopic retrieval of a 5-cm fragile foam foreign body at the rectosigmoid junction using an improvised lithotripter-guidewire device. Download Video A 51-year-old man presented with a rectal foreign body retained for 24 hours. Prior abdominal computed tomography at a local hospital showed partial bowel dilation with gas and minor air-fluid levels, but no distinct high-density radio-opaque object. Patient was referred to our institution after a failed endoscopic retrieval attempt at a community hospital. Urgent flexible sigmoidoscopy identified a large foam-like object at the rectosigmoid junction. Initial extraction with a standard snare failed due to its soft, slippery plastic surface ([ Fig. 1a ]). Subsequent retrieval attempts with oval forceps also failed due to poor grasp. Fig. 1 Side-by-side comparison of endoscopic retrieval attempts. ( a ) A standard snare slipping over the object due to its soft, slippery plastic surface. ( b ) The improvised lithotripter-guidewire device achieving a firm grasp on the friable foreign body. In order to maximize the chance of the en-bloc removal of the potentially fragile foreign body, we improvised to create a retrieval device by combining the basket mechanical lithotripter outer sheath with an endoscopic retrograde cholangiopancreatography guidewire. This combined device achieved a firm grasp and intact removal of the large, fragile foreign body ([ Fig. 1b ]). To construct this device, the guidewire was folded and threaded through the metal sheath to form a distal loop. The device was then inserted via the working channel, and the loop diameter could be easily adjusted by pushing or pulling the external ends of the guidewire ([ Fig. 2 ]). The rigid outer sheath provided solid anatomical support, while the flexible guidewire securely looped around the object. The retrieved object was a square synthetic foam measuring approximately 5 cm in length ([ Fig. 3 ]). Repeat endoscopic examination revealed significant mucosal swelling and multiple ulcers covered with white exudate at the rectum and rectosigmoid junction that were managed conservatively ([ Fig. 4 ]). Fig. 2 Assembly of the improvised lithotripter-guidewire retrieval device. ( a ) The two ends of the guidewire were inserted into the lithotripter sheath. ( b ) The guidewire was threaded through the sheath to exit the proximal end, forming an adjustable distal loop. ( c ) The loop was narrowed to facilitate insertion through the working channel of the endoscope. ( d ) The assembled device. The yellow, white, and red arrows indicate the endoscope, lithotripter sheath, and guidewire loop, respectively. Fig. 3 Gross specimen of the extracted synthetic foam measuring approximately 5 cm. Fig. 4 A post-extraction endoscopic view showing mucosal swelling and scattered ulcers covered with white exudate. Endoscopy_UCTN_Code_TTT_1AQ_2AH Publication History Received: 26 April 2026 Accepted after revision: 26 June 2026 Article published online: 24 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany