Endoscopic removal of a press-through pack from the small bowel using double-balloon enteroscopy

Background and Aims: Press-through packs (PTPs) are a common cause of foreign body ingestion; however, their retention in the small bowel is rare. We present a case in which a PTP lodged at a stenotic site was safely removed using a double-balloon endoscope (DBE). Methods: A 73-year-old woman with a history of ileal tuberculosis and resultant small-bowel stenosis presented with abdominal pain. CT revealed a high-density object in the lower abdomen, suspicious for a foreign body. A retrograde DBE approach was subsequently performed and revealed a PTP lodged in the ileum near the site of stenosis. Results: The PTP was grasped using biopsy forceps, repositioned with a retrieval net, and extracted through the overtube using DBE, with the tip balloon secured by a nylon thread. There were no adverse events during or after the procedure. The patient's symptoms resolved immediately after removal, and no surgical intervention was required. Conclusions: This case demonstrates the utility of DBE, with the tip balloon secured by a nylon thread, in retrieving retained sharp foreign bodies such as PTP. This method enables the safe retrieval of sharp foreign bodies in the small bowel that can be contained within the overtube.