Laparoscopic Removal of Ingested Sewing Needle Migrated to Peripancreatic Tissue

Abstract

Introduction:

The ingested foreign bodies may migrate silently into the surrounding tissues. We report a case of ingested sewing needle that was migrated from stomach and located at peripancreatic tissue. It was removed by laparoscopic surgery.

Materials and Methods:

A 25-year-old woman was referred with chief complaint of back pain for the past 1 month. She had a history of inadvertent ingestion of sewing needle 2 years back, which was not removed. She did not have any symptoms before last 1 month. She did not have any significant psychiatric problems. Physical examination, including abdominal examination, was completely normal. She was not anemic. Abdominal radiograph showed a sewing needle in upper abdomen. Gastrointestinal contrast study demonstrated an extraluminal needle migrated from stomach. To better delineate the location of needle and its relation to vital structure, an abdominal computed tomography (CT) scan was performed, which revealed the location of needle in the peripancreatic tissue, relatively far from major vessels.

Results:

After obtaining the informed consent, she was scheduled for laparoscopic exploration under general anesthesia. The surgeon stood at the right side of patient. After creation of pneumoperitoneum with veress needle, the first 10-mm port for laparoscope was inserted at the infraumbilical ridge. One 5-mm port was inserted in epigastrium for retraction of left lobe of liver. Other two working ports for hand instruments were placed on the sides of camera port. Gastrocolic omentum was divided with aid of LigaSure vessel sealing system (Valleylab, Boulder, CO) with care on preservation of vasculature of great curvature of stomach. With this maneuver, we entered the lesser sac and exploration showed a point of attachment between posterior wall of pyloric canal and retroperitoneal tissues. After meticulous sharp dissection, the sewing needle was found, which was located in the peripancreatic tissue. It was removed with great care under direct observation. Surgical and anesthesiological teams were ready for the occurrence of bleeding, which was not occurred. A stitch was placed at the posterior wall of stomach to ensure closure. A small drain was placed over the pancreas. The operating time was 30 minutes. There was no blood loss and no perioperative morbidity. Postoperative course was uneventful. She was discharged the next day, after toleration of oral feeding and removal of drain. She visited the clinic and did not have any problem 2 weeks after surgery.

Discussion:

Most reported cases of ingested foreign body belong to pediatric or psychiatric populations. The ingested needle may migrate into the surrounding tissues. Usually, this is a silent, slow process allowing development of an inflammatory and fibrotic reaction that results in adhesion formation, thus preventing free intraperitoneal perforation and peritonitis. ¹ The migration of ingested foreign bodies out of the gastrointestinal tract is rare, with <40 reported cases. ² To our knowledge there are two reports of migration of ingested needle from stomach or duodenum to the pancreas. Both were removed through laparotomy. ^3,4 An accurate preoperative localization studies are mandatory. Contrast studies can help demonstrating the extraluminal position of the foreign body. ² CT scan is a good diagnostic modality for detection and accurate localization of the migrated needle. CT scan provides information on the location of needle in relation to great vessels. It also shows the possible surrounding abscess. ¹ Traditionally, the migrated foreign bodies were removed through laparotomy. With the advancements in minimally invasive surgery, there is a trend toward removal of migrated foreign bodies with laparoscopic approach. Patients will enjoy the benefits of minimally invasive approach in comparison to laparotomy, including less postoperative pain, quick recovery and return to normal activities, less overall cost, less wound complications, and better cosmetic results. ^2,5

No competing financial interests exist.

Runtime of video: 3 mins 7 secs