Surgical mystery: where is the missing pituitary rongeur tip?

Breakage of a Pituitary Rongeur Tip: An Unforeseen Complication of Lumbar Microdiscectomy: A Case Report and Review of Literature

CASE

A 46-year-old man with left leg radiculopathy due to a left L4-5 disc extrusion had a lumbar microdiscectomy that was complicated by the pituitary rongeur tip breaking in the L4-5 disc space. The rongeur tip was successfully retrieved by widening the entry access without damaging the adjoining facet and utilizing a blunt nerve hook and probe dissector.

CONCLUSION

Breakage of the pituitary rongeur tip is an unforeseen complication of lumbar microdiscectomy. Surgeons should be aware of this potential complication, ideally confirm the rongeur is intact prior to wound coverage, and understand the risks versus benefits of attempting to retrieve a broken rongeur tip.

Entrapment of a metal foreign body in the heart during surgical procedure: A case report and literature review

A rongeur had been used to remove thin bones in both orthopedic surgery and neurosurgery, featured with a tip holding and cutting bone effectively while protecting the underlying instruments. The authors describe a case of a 40-year-old man who proceeded with the second lumbar vertebrae osteotomy and presented to be ankylosing spondylitis with kyphosis and limited mobility for 10 years. During the surgery, we found that the rongeur tip was missing. C-arm fluoroscopy showed the high-density body just in front of the vertebral body intraoperatively. However, the CT scan showed the foreign body migrated to the right auricle of the heart postoperatively. This case is unique in that there was no exact vessel injury detected intraoperatively. There were few reports about the surgical instrument migrating to the heart. Our case showed the rare experience of the function of multidisciplinary collaboration in the migration of foreign bodies in the cervical spinal canal.

Stepwise Retrieval of a Broken Pituitary Disc Rongeur

We report a case of a patient undergoing open microdiscectomy at L5-S1, wherein the distal tip of a pituitary rongeur became dislodged within the disc space. Complication management and avoidance of anterior advancement are paramount. A stepwise plan to retrieve the foreign body was entertained in a methodical fashion. Such device failure places the patient at greater risk of injury, extends operation time, and adds undue burden on the surgical team. This situation warrants discussing the complications from retained foreign bodies and measures taken for their removal.