Endoscopic Salvage of Colonic Obstruction Caused by an Unidentified Fibrous Foreign Body.

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.

Learning points: Introduces a practical, surgery-sparing endoscopic strategy combining balloon sweeping and lubrication to successfully relieve a complete colonic obstruction after failure of conventional retrieval tools.Provides internists with an actionable escalation pathway for refractory large bowel foreign body impactions, potentially preventing hemicolectomy and reducing morbidity in otherwise stable patients.Highlights a strategic multi-modal treatment algorithm the work showcases a comprehensive management approach-combining mechanical fragmentation, chemical lubrication with mineral oil, and post-procedural osmotic laxatives-to resolve high-grade colonic obstructions safely and completely.