Odyssey of an accidently ingested sewing needle from mouth to mesentery of small bowel in a young female - Case Report

Foreign body (FB) ingestion is one of the most common complaint in the emergency room and, extra-intestinal migration of penetrating sharp FBs is one of the most overlooked aspect of medical research. We report a case of accidental ingestion of a sewing needle which was recovered from the mesentery. The 28-year-old female presented to our hospital with abdominal pain and one-month's history of needle ingestion. Initially laparoscopy was performed, which was inconclusive. Afterward, through laparotomy, the needle was successfully removed from the mesentery of small bowel.

Endovascular Retrieval of Intracaval Cement: A Fishing Net Technique

PURPOSE

To describe a novel endovascular technique for intracaval cement retrieval after spinal surgery.

TECHNIQUE

We produced a replica of the intracaval cement fragment and a 3D print to plan the endovascular procedure. A woven caval filter was modified with two drawstring sutures to be used as fishing net. We used a 10F sheath in the right internal jugular vein to place the caval filter proximal to the floating fragment, and a 24F sheath in the right femoral vein was the working access. After the deployment of the caval filter, the following steps were performed through the 24F sheath: (A) The drawstring sutures were snared and retrieved to the skin surface in the groin; (B) the fragment was secured with two snare catheters from the femoral access and one through the lumen of the caval filter; (C) the fragment was broken off with a snared guide wire at the base; (D) the smallest fragment was removed directly with the snare; (E) the larger dislodged fragment was controlled within the periprocedural caval filter by tightening the drawstring and removed through the 24F sheath.

CONCLUSION

Cement fragments located in the inferior vena cava after cement-augmented spinal surgery procedures can be safely removed by the described fishing net technique.

Unusual migration of a Kirschner wire in a patient with Osteogenesis Imperfecta: A case report

RATIONALE

Kirschner wires (K-wires) are the most commonly used implants in orthopedic surgery. Although complications are not uncommon, they are mostly benign in nature and easily managed. While migration of K-wires is a rare complication, fatal outcomes have been reported. A review of the literature showed that only 7 cases of wire migration in the hip and pelvic region have been reported. Only 2 occurred in the pediatric population. Although K-wires are routinely used in osteogenesis imperfecta (OI) patients, there has been no report of complications in this vulnerable patient population.

PATIENT CONCERNS

A 10-year-old girl with OI, presenting with gastrointestinal symptoms 1 year after operative fixation of a subtrochanteric femoral fracture. Pelvic x-ray showed a missing K-wire.

DIAGNOSIS

The patient was diagnosed with migration of a K-wire from the left femoral neck to the right retroperitoneal space.

INTERVENTIONS

The patient underwent surgery. During the operation, the migrated K-wire was extracted from just below the 12th rib on the right side.

OUTCOMES

The patient had an uneventful rehabilitation, recovered completely, and was asymptomatic at 2-year follow-up.

LESSONS

There has been no prior report of migrated K-wires in the OI population. This is also the first report of a K-wire migrating from the femoral neck to the contralateral retroperitoneal region. Proper intraoperative bending of K-wires, timely removal of temporary K-wires, and considering K-wire migration in patients with retained hardware complaining of respiratory or gastrointestinal symptoms will prevent potentially life-threatening complications.

Complications and Radiologic Features of Breast Augmentation via Injection of Aquafilling Gel

Many attempts have been made to augment breasts using injectable materials; however, various complications are associated with these materials. Aquafilling gel (Aquafilling, Poděbrady, Czech Republic) is a new soft tissue filler that has been used as an implant material for the face and lip and recently for breast augmentation. This article describes 3 cases of augmentation mammoplasty using Aquafilling gel, focusing on their complications and radiologic features.

A migratory shark bone

Fish bone ingestion is a common presentation in ENT. If not managed correctly, it can cause serious complications for the patient and dilemmas for the clinician. A 49-year-old Sri Lankan woman presented to the emergency department following shark bone ingestion with a 'pricking' sensation in her throat. After initial investigation, the bone migrated through to the sternocleidomastoid muscle. After surgical removal of the shark bone she went on to develop a large neck collection, which required surgical drainage. The careful attention to the patient's history and use of imaging facilitated treatment in this case of fish bone ingestion and management of the sequelae.

Complications and Management of Implants Migrated into the Maxillary Sinus

The article describes complications following dental implant dislocation into the maxillary sinus and their management and attempts to elucidate the reasons for these complications and their prevention. This retrospective study presents 55 cases of dental implant migration into the maxillary sinus. Patients were 30 men and 25 women with average age of 58 years. Oroantral communication was found in 46 cases, primarily in cases without prior bone augmentation, in patients aged older than 60 years (mean), and medically compromised patients (ASA > 1). The dislocated implant and the infected tissue were removed from the sinus in most cases by Caldwell-luc intervention. The oroantral communication was closed by local and regional flaps. In most of the cases, the oroantral communication was closed by a single intervention. The conclusion was that oroantral communication and maxillary sinusitis are common findings following dental implant migration and dislocation into the maxillary sinus. The risk factors for these complications were dental implantation in the posterior maxilla without sufficient alveolar bone, implantation without prior maxillary sinus augmentation, and older and medically compromised patients. Successful closure of the communication is usually performed with local or regional flaps.

Ileocecal junction perforation caused by a sewing needle in incarcerated inguinal hernia: An unusual case report

INTRODUCTION

This case study is concerning the meticulous observation of the moving process and track of 2 ingested needles using interval x-ray radiography, trying to localize the foreign bodies and reduce unnecessary exploration of digestive tract.

CASE PRESENTATION

An unusual case of a 1-year, 9-month-old female baby, with incarcerated hernia perforation caused by sewing needles with sharp ends, was reported herein. The patient had swallowed 2 sewing needles. One needle was excreted uneventfully after 8 days. On the contrary, the other needle stabbed the ileocecal junction wall into the right side of inguinal hernia sac after 9 days, and the patient received successful operation management. Interval x-ray confirmed that 1 needle-like foreign body moving down in 8 days until excretion along with feces. However, the other pierced into the incarcerated hernia. Preoperative x-ray radiography successfully monitored the moving process and tract of the sewing needles. Considering the penetrating-migrating nature of the foreign bodies, once the sharp-pointed objects were located, they should be removed as the mortality and risk of related complications may be increased.

CONCLUSION

Interval x-ray radiography represents a meticulous preoperative monitoring method of the moving process and tract of needle-like foreign bodies. Interval x-ray with real-time images accurately detecting the moving foreign bodies could be help to reduce the unnecessary exploration of digestive tract and subsequently prevent possible complications. Based on the basic findings from the interval x-ray, treatment choices of endoscopic removal and surgical intervention may be attempted.

A foreign body in the cephalic vein: A case report

RATIONALE

Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient.

PATIENT CONCERNS

Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury.

DIAGNOSES

X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location.

INTERVENTIONS

The foreign body was removed completely following a microsuture of the cephalic vein.

OUTCOMES

The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up.

LESSONS

This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.

Removal of Polyacrylamide Gel (Aquamid®) from the Lip as a Solution for Late-Onset Complications: Our 8-Year Experience

BACKGROUND

The polyacrylamide hydrogel Aquamid^® has been used as a permanent filler to enhance facial soft tissue volume and correct wrinkles since 2001. Various long-term studies have proved the safety of the product. Nonetheless, if complications such as migration occur, they can be difficult to treat.

METHODS

Eleven patients suffering from late-onset complications after taking Aquamid^® injections in the lips underwent product removal and subsequent labial reconstruction between 2009 and 2017. The reconstruction was performed using a modified bikini reduction technique combined, in eight cases, with immediate autologous fat grafting.

RESULTS

In all the patients, general fibrosis and a diffused distribution of the product within all three layers of the lips resulted in the need for labial reconstruction. Migration, as far as in the mucosa and perioral skin, accounted for macroscopically visible yellowish accumulations. In ten out of eleven cases, an individually modified bikini reduction technique, with or without any combination of autologous fat grafting, led to an esthetically satisfying result. One patient developed a severe upper lip necrosis.

CONCLUSION

Contradictory to several previous studies attesting to the lack of migration after Aquamid^® application to the lips, capsule formation around the product is impaired, allowing for migration even years after the injection. Product aspiration is not possible in these cases, thus necessitating complex lip reconstruction. Bikini reduction and fat grafting are valuable tools for labial reconstruction. Product residuals within the mucosa have to be accepted. Special care has to be taken while treating smokers.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Self extrusion on an ingested foreign body: a case report

Foreign body ingestion is a frequent issue in paediatrician's practice. Foreign bodies often pass the gastro-intestinal tract spontaneously but can sometimes generate complications (1% of the cases). The migration of ingested foreign bodies is rare, but their spontaneous extrusion through the skin is even rarer and was previously described only in the neck. We report an unusual case of a spontaneous extrusion of an ingested foreign body through the skin of the lower abdomen. Observation: A 2 year-old boy, presented with a 2cm inflammatory swelling of the hypogastric region. Laboratory analysis showed hyperleukocytosis (16 7770 /mm3) and high C reactive protein level at 12mg/L. Ultrasonography and computed tomography allowed us to diagnose a parietal foreign body extruding through the skin and to eliminate associated complication (perforation, vascular fistula…). The foreign body was extracted by a surgical incision. This observation is very rare but it is also uncommon because of the nature of the ingested foreign body which was a wooden piece. Its ingestion was explained by a paediatric mental disorder.

Intralacrimal migration of Masterka® stents

BACKGROUND

Tearing and conjunctivitis in children are commonly due to lacrimal drainage system obstruction. Congenital nasolacrimal obstruction is a common pathology treated by probing with or without silicone stent insertion, depending upon the age of the child. The silicone stent is self-retaining and placed for at least one month. Masterka^® is a recent version of Monoka^®, which may lead to the same surgical complications, such as intralacrimal migration.

SUBJECTS AND METHODS

The medical records of two patients surgically treated with the Masterka^® probe for nasolacrimal duct obstruction, who developed intralacrimal migration of the stent, were retrospectively reviewed and analyzed. A 41-month-old child and an 18-month-old child presented with disappearance of the silicone tube after 7 days and 2 years respectively. In the first case, the tube migrated completely within the lacrimal system and became externalized through the nose at 2 years, while in the second case, the Masterka^® was retrieved through a canalicular approach. In both cases, infants had no further tearing.

DISCUSSION

The frequency self-retaining stent disappearance is estimated at 15%. Among these cases, intralacrimal migration is only reported in 0.5% of cases. To prevent intralacrimal migration, the surgical technique must follow a certain number of rules. Management, based on residual epiphora, is discussed.

CONCLUSION

Prevention of intralacrimal migration of self-retaining stents involves a rigorous analysis of the relationship between the meatus and the fixation head at the time of placement. After lacrimal intubation, scheduled monitoring is necessary to screen for stent disappearance. Management is based on clinical findings, anterior rhinoscopy and even exploratory canaliculotomy.

Two-Stage Procedure for Management of Large Exposure Defects of Hydroxyapatite Orbital Implant

PURPOSE

To report the results of a newly devised two-stage surgical technique for management of large hydroxyapatite exposure defects.

METHODS

Eight patients with exposed hydroxyapatite orbital implant were treated in two stages. The exposed hydroxyapatite anterior surface was burred down and the defect was directly closed 3 to 13 months after the primary procedure. Then a mucous membrane or dermis-fat graft was added for socket reconstruction.

RESULTS

Trauma was the primary cause of enucleation in all patients. Hydroxyapatite exposures occurred 1 to 2 weeks after implantation. Mean defect size was 15 mm in the greatest dimension (range 10-21 mm). Socket reconstruction was done in seven patients with mucous membrane graft and in one patient with dermis fat graft 3 to 13 months after direct repair of the defects. All eight patients maintained closure of the defects during a mean follow-up of 13 months (range 9-19 months).

CONCLUSIONS

Management of hydroxyapatite exposures, especially those with large defects, can be difficult. Based on our experience, optimal results can be obtained after direct closure of the defect under minimal tension at the expense of foreshortening the fornices after which the socket can be reconstructed with a mucous membrane or dermis fat graft as a secondary procedure.

Endovascular retrieval of Greenfield IVC filters 13 and 19 years post placement without major complication

Inferior vena cava (IVC) filters were first introduced in 1967 by Kazi Mobin-Uddin and later improved by Lazar Greenfield in the 1980s becoming a major component of catastrophic pulmonary embolism prevention. Nevertheless, filters are not entirely harmless. The long term risks include caval thrombosis, visceral penetration, and filters can serve as a nidus for infection. Filter retrieval is often complicated by intimal hyperplasia especially with increased indwelling time. Historically, Greenfield filters in place for longer than 3 weeks were considered permanent due to the risks of retrieval. Herein we present 2 cases of successful retrieval of Greenfield filters 13 and 19 years post implantation.

Removal of a subdermal contraceptive implant (Implanon NXT) that migrated to the axilla by C-arm guidance: A case report and review of the literature

RATIONALE

To report the distant migration of a subdermal contraceptive implant and to suggest that C arm-guided technique is one of the feasible options for removal of the device migrated to the axilla.

PATIENT CONCERNS

A 41-year-old multipara with tingling sensation in the left axilla was referred for removal of an Implanon NXT which could not be palpated by physical examination or detected by ultrasound scanning. Finally, the device was detected by computed tomography and found migrating to the left axilla.

DIAGNOSIS

Migration of Implanon NXT to the left axilla abutting the brachial plexus.

INTERVENTIONS

The device was removed by C arm-guiding.

OUTCOMES

The patient went home without any procedure-related complications.

LESSONS

The incidence of distant migration of a subdermal implant is possible and should be checked up regularly. If the device cannot be palpated or detected by ultrasound at the original implanting site, this should be concerned. Since the single-rod subdermal implant is radiopaque, it can be detected by roentgenography. In this case the distant migration was detected in the axilla, therefore using C arm-guided technique is feasible for the removal of the migrating device. After reviewing the literature, totally 10 cases of distant migration were reported including 2 cases of migration which were advanced further to the pulmonary artery as an embolization.

Migration of a stent from left main and its retrieval from femoral artery: A case report

RATIONALE

Embolization of a deployed stent is a rare complication and its mechanism remains unclear in most cases.

PATIENT CONCERNS

A 52-year-old man underwent coronary angiography for effort angina, revealing an 80% stenosis of the proximal left anterior descending (LAD) involving the distal left main (LM). After luminal sizing with intravascular ultrasound two drug-eluting stents were deployed (5.0 × 12 mm and 3.5 × 15 mm) to cover the LM-LAD lesion. After postdilatation, the proximal stent had disappeared from the LM.

DIAGNOSES

The missing stent was found in the right deep femoral artery.

INTERVENTIONS

A new 5.0 × 15 mm stent was deployed onto the LM-LAD ostium, in overlapping with the previously implanted. Then, the stent migrated to the deep femoral artery was successfully retieved through the contralateral femoral artery.

OUTCOMES

The patient was discharged 2 days later, after an uneventful hospital stay.

LESSONS

Stent deformation after postdilation is a possible causes of stent migration.

Early Dislodgment and Migration of a Left Atrial Appendage Closure Device

A 68-year-old man underwent pulmonary vein isolation with cryoballoon combined with left atrial appendage closure using a LAmbre device. The device was dislodged and embolized early after implantation with no symptoms, and it was retrieved percutaneously. An early in-hospital check of the device position after implantation is important for early recognition of any possible device-related complication.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (P<.02). A risk factor for lateralization was AO classification, with 46.1% of type A2 fractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (P<.001) and removal of hardware because of trochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.].

Scleral suture fixation technique for dislocated plate haptic toric IOL

Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error.

Cephalad Lead Migration During a Spinal Cord Stimulation Trial: A Case Presentation

Spinal cord stimulation is used in the treatment of a variety of pain conditions. Lead migration is among the most common complications associated with spinal cord stimulation. Although there have been reports of caudal lead migration, there have been no reports of significant cephalad lead migration during a spinal cord stimulation trial. Here we report what is potentially the first case of significant cephalad lead migration (from the initial T8 position to C2) during a spinal cord stimulation trial. This case demonstrates that significant lead migration is possible, and this case highlights the importance of adequately securing leads during a trial.

LEVEL OF EVIDENCE

V.

Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilatation for achalasia treatment

The aim of this study is to compare endoscopic stent suture fixation with endoscopic clip attachment or the use of partially covered stents (PCS) regarding their capability to prevent stent migration during prolonged dilatation in achalasia. Large-diameter self-expanding metal stents (30 mm × 80 mm) were placed across the gastroesophageal junction in 11 patients with achalasia. Stent removal was scheduled after 4 to 7 days. To prevent stent dislocation, endoscopic clip attachment, endoscopic stent suture fixation, or PCS were used. The Eckardt score was evaluated before and 6 months after prolonged dilatation. After endoscopic stent suture fixation, no (0/4) sutured stent migrated. When endoscopic clips were used, 80% (4/5) clipped stents migrated (p = 0.02). Of two PCS (n = 2), one migrated and one became embedded leading to difficult stent removal. Technical adverse events were not seen in endoscopic stent suture fixation but were significantly correlated with the use of clips or PCS (r = 0.828, p = 0.02). Overall, 72% of patients were in remission regarding their achalasia symptoms 6 months after prolonged dilatation. Endoscopic suture fixation of esophageal stents but not clip attachment appears to be the best method of preventing early migration of esophageal stents placed at difficult locations such as at the naive gastroesophageal junction.