Retroperitoneal hematoma due to rupture of a pseudoaneurysm caused by acupuncture therapy

A Cumulative Review of the Range and Incidence of Significant Adverse Events Associated with Acupuncture

Objective

To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice.

Methods

Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events.

Results

A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients.

Conclusions

The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.

Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty

Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. Necrotizing fasciitis is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of serious cervical necrotizing fasciitis that developed after acupuncture and herbal injection treatment of fat accumulation of the submental area in a 32-year-old healthy woman. She presented with discharging wound over the submental area. The initial diagnosis was based on clinical information, in which localized necrosis areas in the cervical and chin regions were observed. Wide antibiotic therapy was applied, followed by surgical drainage, debridement, and negative pressure wound therapy. Culture was positive for Serratia liquefaciens and Staphylococcus intermedius. She made a good recovery.

Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture

Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery.

Necrotizing fasciitis after acupuncture in a patient with aplastic anemia

OBJECTIVES

The objective of this study was to describe a serious complication of acupuncture treatment in a high-risk patient with aplastic anemia.

DESIGN

A 44-year-old woman with aplastic anemia experienced right calf pain after running. After poor results with physical therapy, she received needle acupuncture for pain relief. However, aggravated pain with swelling of the right calf developed 2 days later.

RESULTS

On admission, she had a temperature of 38.8°C, a white blood cell count of 500/μL, and hemoglobin of 5.7 g/dL. Ultrasound and computed tomography scans showed swelling of the right calf muscle fascia, and aspiration drew out Staphylococcus infection. The symptoms improved after treatment with parenteral antibiotics.

CONCLUSIONS

This case illustrates that necrotizing fasciitis must be considered as a possible complication of acupuncture in high-risk patients, and that early recognition and treatment of this life-threatening soft-tissue infection must be emphasized. Extreme caution should be employed when using acupuncture for high-risk patients, such as those with aplastic anemia.

Vascular injuries caused by acupuncture

AIM

To systematically review the literature on vascular injuries caused by acupuncture.

METHOD

Systematic literature search in Medline and PubMed.

RESULTS

Twentyone cases were identified and the majority developed symptoms in direct connection with the acupuncture treatment. Three patients died, two from pericardial tamponade and one from an aortoduodenal fistula. There were five more tamponades, seven pseudoaneurysms, two with ischaemia, two with venous thrombosis, one with compartment syndrome and one with bleeding. The two patients with ischaemia had remaining sequeleae. Information on follow-up was suboptimal with no information in nine patients.

CONCLUSION

Vascular injuries are rare, bleeding and pseudoaneurysm dominating. Follow-up is insufficient in the hitherto published papers.

Adverse effects of unconventional therapies in the elderly: A systematic review of the recent literature

Unconventional therapies are increasingly popular, not least in populations of elderly individuals. This review summarizes the evidence regarding the risk unconventional therapies may entail for the elderly. Computerized literature searches were performed to locate all reports with original data on this topic. Most of the evidence found was anecdotal by nature and thus has obvious limitations. The results show that elderly patients can suffer harm from unconventional therapies. Herbal treatments are associated most frequently with adverse events. They can cause both direct toxicity and unwanted herb-drug interactions. Acupuncture, spinal manipulation and even massage therapy have also been implicated. Indirect risks exist if unconventional therapies are employed as a substitute for conventional treatments. It is concluded that unconventional therapies are not risk-free for elderly patients. All parties involved ought to be educated with a view of minimizing this risk, and more research is needed to increase our understanding of this area.

Rare but serious complications of acupuncture: traumatic lesions

Acupuncture has a reputation among the public of being safe. Although recently performed prospective studies on the frequency of adverse effects of acupuncture found no severe complication, since 1965 many case reports of serious or even life-threatening incidents caused by acupuncture have appeared in the scientific literature. The most frequently reported complications are pneumothorax and lesions of the spinal cord. Severe injuries of peripheral nerves and blood vessels due to acupuncture seem to be very rare. Although case reports do not produce reliable data on the frequency of adverse events. information on sources of application errors can be extracted to increase the quality of acupuncture in education and therapy. All traumatic injuries described in this article could be avoided if practitioners had better anatomical knowledge, applied existing anatomical knowledge better, or both.

Systematic review of adverse events following acupuncture: the Japanese literature

CONTEXT

Many Japanese cases of adverse events after acupuncture are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside Japan.

OBJECTIVE

To complement existing reviews of adverse events after acupuncture in the West and to provide more detailed discussion and analysis.

DATA SOURCES

Literature search using 'Igaku Chuo Zasshi (Japana Centra Revuo Medicina) CD-ROM version' covering the period of 1987-1999.

STUDY SELECTION

Case reports of adverse events, which were suspected to be due to acupuncture treatment, were included. Experimental studies, surveys, and news articles were excluded.

DATA EXTRACTION

Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed likelihood of causality in each individual case.

DATA SYNTHESIS

89 articles which reported 124 cases were located. The most frequent adverse events were: pneumothorax (25 cases), spinal cord injury (18 cases), acute hepatitis B (11 cases), and localized argyria (10 cases). There were two fatalities from infections. Forty-eight events were caused by needle breakage including 26 cases of intentionally embedded needle and 16 cases of accidental breakage. There were also 10 cases of injury from self-treatment.

CONCLUSION

Although it has already been demonstrated that severe adverse events seem to be uncommon in standard practice, many serious cases of negligence have been found in the present review, suggesting that training system for acupuncturists (including medical doctors) should be improved and that unsupervised self-treatment should be discouraged.