A self-made wire snare used in combination with a long transparent cap to remove an obstructive sigmoid fecalith

Abstract

Figures

a Computed tomography revealed a mixed-density mass measuring 3.63 cm × 2.65 cm in the sigmoid colon. b Colonoscopy revealed a large black-brown fecalith situated in the sigmoid colon. c A self-made snare fabricated from a zebra guidewire and integrated with a long transparent cap was utilized to remove the fecalith. d The fecalith was successfully fragmented, and all resulting fragments were completely removed.

Full text

A 68-year-old female was admitted to our hospital with a 5-day history of abdominal pain and vomiting. Computed tomography revealed a mixed-density mass measuring 3.63 cm × 2.65 cm in the sigmoid colon, containing sieve-like low-density areas, along with proximal colonic dilation and fluid accumulation, which are consistent with the presence of a sigmoid colonic fecalith accompanied by colonic obstruction ( Fig. 1 a ). The patient chose to undergo endoscopic intervention. Colonoscopy revealed a large black-brown fecalith situated in the sigmoid colon, resulting in complete luminal occlusion and preventing further advancement of the endoscope ( Fig. 1 b ). An initial attempt was made to remove the fecalith using a conventional snare; however, the procedure was unsuccessful due to the relatively large size and hardened consistency of the fecalith. Subsequently, a self-made snare fabricated from a zebra guidewire and integrated with a long transparent cap was utilized ( Video 1 ). The fecalith was successfully fragmented, and all resulting fragments were completely removed ( Fig. 1 c, d ). No postoperative bleeding or perforation was observed, and the patientʼs abdominal pain significantly improved. She resumed spontaneous bowel movements and was discharged on the second postoperative day.

a Computed tomography revealed a mixed-density mass measuring 3.63 cm × 2.65 cm in the sigmoid colon. b Colonoscopy revealed a large black-brown fecalith situated in the sigmoid colon. c A self-made snare fabricated from a zebra guidewire and integrated with a long transparent cap was utilized to remove the fecalith. d The fecalith was successfully fragmented, and all resulting fragments were completely removed.

A self-made wire snare used in combination with a long transparent cap to remove an obstructive sigmoid fecalith.Video 1

Fecalith-induced colonic obstruction is not uncommon. However, endoscopic management of fecaliths remains challenging due to their typically large size and hard consistency 1 . Although the combination of a self-made wire snare and a long transparent cap has been reported to be effective in the treatment of giant phytobezoars 2 , its application in the management of colonic fecaliths has not been previously documented. Compared with the stomach, the colon provides a more limited working space, particularly in cases of obstruction where endoscopic visualization is impaired. Our case demonstrates that a self-made snare incorporating a long transparent cap can effectively remove the obstructive sigmoid colonic fecalith.

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