Novel use of cholangioscopy-assisted enteroscopy for foreign body removal from a narrow-ostium ileal diverticulum

A 13-year-old girl was presented with a 20-day history of right-sided abdominal pain. She denied consuming any special foods. Computed tomography (CT) revealed a high-density focus in the right lower abdomen, suggestive of an intestinal foreign body ([Fig. 1]). Given the high surgical risk and uncertain prognosis, double-balloon enteroscopy was performed via a retrograde approach. At the site 100 cm proximal to an ileocecal valve, a “double lumen” sign was observed ([Fig. 2] a), comprising the intestinal lumen and a narrow-opening diverticulum ([Fig. 2] b). Endoscopic visualization identified a rod-like foreign body embedded within the diverticulum ([Fig. 2] c). A conical transparent cap was attached to the enteroscopy tip to facilitate retrieval. With the cap stabilized at the orifice, the foreign body was successfully retrieved using biopsy forceps, which confirmed a 1.4 cm chicken bone ([Fig. 3]). Post-retrieval bleeding was noted; however, the narrow opening limited further visualization. For detailed assessment, a digital single-operator cholangioscope was inserted into the diverticulum cavity ([Fig. 4] a), providing clear visualization of a short cavity with mucosal edema and minor blood clots. After irrigation, no residual foreign body, active bleeding, or perforation was confirmed. ([Fig. 4] b, [Video 1]).

Fig. 1 A computed tomographic image showing a high-density shadow in the right lower quadrant of abdomen, indicating an intestinal foreign body.

Fig. 2 An image from double-balloon enteroscopy: a the “double lumen” sign at the ileum about 100 cm beyond the ileocecal valve; b the narrow opening of the ileal diverticulum; c a bone foreign body in the diverticulum, and the inner wall of diverticulum cannot be observed.

Fig. 3 Photograph of the extracted foreign object, which was found to be a 1.4-cm chicken bone.

Fig. 4 Image of the digital single-operator cholangioscope: a Intubation of the diverticulum with the cholangioscope. b Observing the condition of the inner wall of the diverticulum.

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Removal of a foreign body from an ileal narrow-opening diverticulum via enteroscopy assisted with a digital single-operator cholangioscope.Video 1

The extraction of sharp foreign bodies from the small intestine is technically challenging with enteroscopic techniques [1]. This difficulty is further exacerbated when the foreign body is lodged within a diverticulum featuring a narrow ostium, which precludes direct visualization. The cholangioscopy [2] can be navigated through these confined openings to effectively address this scenario. To the best of our knowledge, this is the first reported case in which a foreign body was successfully retrieved from an ileal diverticulum with a narrow ostium. Additionally, it marks the novel application of cholangioscopy in conjunction with double-balloon enteroscopy. This integrated approach provided a minimally invasive alternative, avoiding the need for surgery.

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Contributorsʼ Statement

Jing Guo: Conceptualization, Data curation, Investigation, Resources, Writing – original draft. Yanbo Yu: Conceptualization, Writing – review & editing. Rui Ji: Data curation, Methodology, Validation. Jun Liu: Data curation, Writing – review & editing. Xiu-Li Zuo: Conceptualization, Data curation, Project administration, Resources, Supervision, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Pennazio M, Rondonotti E, Despott EJ. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-Update 2022. Endoscopy 2023; 55: 58-95
• 2 Dezheng Lin, Mingli Su, Yuping Su. et al. Digital single-operator cholangioscope-assisted endoscopic retrograde appendicitis therapy in the management of Crohnʼs disease with acute appendicitis. Endoscopy 2024; 56 (Suppl. 01) E791-E792

Publication History

Article published online:
22 January 2026