Enteroliths, faecaliths, ingested foreign bodies, and bezoars are examples of focal intraluminal obstructions that can lodge in inaccessible parts of the gastrointestinal tract. Pneumatic lithotripsy, as described in the accompanying article, is an option to manage obstructions caused by mineralized concretions. However, pneumatic lithotripsy may not be safe or effective for all intraluminal obstructions. Awareness of other strategies or secondary abdominal approaches to address these challenging presentations can help improve the surgeon's ability to problem solve in these situations and achieve successful resolution of the obstruction.