Post written by Jad P. AbiMansour, MD, from the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
This video case is about a 65-year-old carpenter who had a CT scan performed for back pain and was incidentally found to have a metallic screw retained in his appendix. The surgical team referred the patient to gastroenterology to attempt endoscopic retrieval prior to consideration of appendectomy.
Because of the patient’s anatomy and position of the screw, retrieval was challenging, and routine extraction techniques were unsuccessful. The screw was eventually removed using a novel magnetic catheter constructed using parts routinely stocked in most endoscopy suites. The magnetic tip from the end of the nasal bridle was cut and attached to the distal end of a standard snare catheter using zinc oxide tape.
This magnetic catheter could then be passed into the working channel of the colonoscope and into the appendiceal lumen. The magnet made contact with the head of the screw, allowing for successful extraction with withdrawal of the catheter.
The patient did well postprocedurally, and appendectomy was deferred.
This video highlights the challenging nature of appendiceal foreign body removal, particularly given the variable anatomy that can be seen. In addition, it is a strong example of endoscopic problem-solving and innovation that prevented the need for abdominal surgery.
The appendix can be found in many different positions in relation to the cecum. Endoscopic foreign body retrieval can be considered with appropriate patient selection, careful planning, and multidisciplinary involvement. A methodical, stepwise approach that incorporates available tools, including fluoroscopy and creative devices such as the one described here, will increase the likelihood of successful extraction.
Novel magnetic catheter derived from nasal bridle kit.
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