A sewing needle in the liver: 6 years later

A rare case of retained metallic foreign body in liver: case report and review of literature

Introduction and importance

Foreign bodies in the liver are uncommon but can lead to severe conditions like liver abscess and sepsis. They typically enter through direct penetration, migration from the gastrointestinal tract, or through the blood. Common foreign objects include metal pins, or sewing needles swallowed accidentally.

Case presentation

A 25-year-old male presented to our OPD with pain over the right abdomen with a prior history of projectile injury causing laceration over the right anterior abdomen with primary suturing. On radiological investigation, a retained foreign body was revealed. The metallic foreign body was embedded in the liver for 5 months. Removal of the foreign body was performed without any complications.

Clinical discussion

Intrahepatic foreign bodies (FBs) in the liver can result from penetrating injuries, iatrogenic causes, or ingestion, particularly in children. Clinical presentations vary, and complications such as abscess formation may occur. Diagnosis involves imaging modalities like X-rays, ultrasonography, and computed tomography (CT) scans. The presented case highlights the importance of meticulous follow-up, as chronic pain manifested despite conservative management. The management of intrahepatic FBs depends on factors like size, location, and symptoms, with conservative approaches for stable patients. Surgical removal remains the mainstay of the treatment. Long-term monitoring is crucial to detect potential complications, and imaging studies play a key role in regular follow-up.

Conclusion

Hepatic foreign bodies are rare, and symptoms vary based on size, type, and location, ranging from asymptomatic to complications such as abscess formation. Surgical removal is the main treatment, but in cases of noncomplicated hepatic foreign bodies, close follow-up is necessary.

A sewing needle in the liver: a case report and literature review

Intrahepatic foreign bodies are rarely reported. Although rare, a few reports of swallowed foreign bodies straying into the liver from the gastrointestinal tract have been published. Herein, we report a case in which an asymptomatic intrahepatic needle was removed laparoscopically. An 81-year-old woman presented to our hospital with an abnormal shadow on her abdominal X-ray image. Abdominal computed tomography displayed a needle-like shadow obliquely lying in the lateral segment of the left lobe of the liver. No subjective symptoms were reported; however, the patient underwent laparoscopic extraction. The postoperative course was good, and the patient was discharged without any complications. We also present a literature review of 27 patients with intrahepatic foreign bodies, a sewing needle.

A sewing needle in the liver in children: A case report and literature review

RATIONALE

In clinical practice, foreign bodies (FBs) in the digestive tract are more common in children, but intrahepatic FBs are rare, especially those that can cause infection, bleeding, bile leakage, and other complications. However, there is no consensus on its diagnosis and treatment due to the lack of large-scale cohort studies.

PATIENT CONCERNS

Case 1 is a 4-years 8-months-old girl, who at the age of 10 months, showed an X-ray finding of a striped FB in her liver, with no symptoms. However, the patient's parents refused surgery. After nearly 4 years of active surveillance, the patient visited our hospital for surgery. Case 2, a 2-year-old male, reported a sewing needle that completely pierced into the right upper abdomen due to an accidental fall that took place half-a-day before admission. He only had right upper abdominal pain. CT showed a striped FB in the liver.

DIAGNOSIS

FB in the liver (sewing needle).

INTERVENTIONS

Both the patients were injected with human tetanus immunoglobulin and underwent surgical removal.

OUTCOMES

Both patients recovered smoothly and had no complications during follow-up.

LESSONS

Active surveillance might be considered for cases with no symptoms or complications and no displacement of the FB, but surgery should be the first choice. If the patient's condition is complicated, it is recommended to use ultrasound or X-ray to help decision-making during the operation. Additionally, tetanus, child safety, and family education are important supportive measures.

Epidemiology and Surgical Management of Foreign Bodies in the Liver in the Pediatric Population: A Systematic Review of the Literature

Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can bring a heavy burden in terms of immediate and long-term complications. Multiple materials can migrate inside the liver. Clinical manifestations may vary, depending on the nature of the foreign body, its route of penetration and timing after the initial event. Moreover, the location of the FB inside the liver parenchyma may pose specific issues related to the possible complications of a challenging surgical extraction. Different clinical settings and the need for highly specialized surgical skills may influence the overall management of these children. Given the rarity of this event, a systematic review of the literature on this topic was conducted and confirmed the pivotal role of surgery in the pediatric population.

Laparoscopic retrieval of a sewing needle from the liver: A case report

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Ingested foreign bodies are a common presentation.

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Ingested foreign bodies can migrate/penetrate to the liver.

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Patients can present with symptoms including epigastric abdominal pain.

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In some cases hepatic foreign bodies can be extracted through a laparoscopic approach.

Introduction

Less than 1% of ingested foreign bodies will require surgical management. An uncommon complication of ingested foreign body is migration to the liver. We present a case of laparoscopic removal of an intrahepatic foreign body.

Presentation of case

32-year-old female presented with a four month history of epigastric abdominal pain following suspected foreign body ingestion. CT scan demonstrated a metallic object lying in the left lateral segment of the liver. The patient was brought to the operating room where the object was removed laparoscopically and was found to be a sewing needle.

Discussion

Hepatic foreign bodies are an uncommon entity and typically result from a transcutaneous or ingested (e.g., gastrointestinal) source. Symptoms are often vague and can develop remote from the time of ingestion. Surgical management is warranted for symptomatic intrahepatic foreign bodies.

Conclusion

Laparoscopy is an effective surgical method for removal of intrahepatic foreign bodies in some cases.

A sewing needle in contact with the cervical dura mater and vertebral artery: A case report

RATIONALE

Although cervical foreign bodies have been previously reported, the report of a needle in the cervical spinal cord is rare. Herein, we report a rare case of a sewing needle in contact with the cervical dura mater and vertebral artery.

PATIENTS CONCERNS

A 47-year-old man presented with discomfort in the posterior region of his neck. Approximately 2 years before admission, he suffered a stiff neck and had stabbed the posterior region of his neck with a sewing needle. The sewing needle had deeply entered his neck, and he left it alone because it could not be identified or removed. On examination, the patient had a full range of neck motion, but was experiencing discomfort. Cervical spine radiographs revealed a metal foreign body oriented from between the C2 and C3 spinous processes to the anterior cervical spine.

DIAGNOSIS

Computed tomography (CT) myelogram and CT angiogram revealed that the sewing needle was penetrating into the foramen transversarium and was in contact with the cervical dura mater and the right vertebral artery.

INTERVENTIONS

The sewing needle was removed under general anesthesia.

OUTCOMES

Cerebrospinal fluid leakage occurred immediately after removal of the needle. Symptoms of discomfort disappeared without any complications.

LESSONS

This is the first report of a sewing needle that entered the cervical spinal canal while avoiding the cervical spine and the vertebral artery. Although no symptoms occurred for nearly 2 years, surgical removal of a foreign body near the cervical spinal cord and vertebral artery should be performed as soon as possible, before the occurrence of symptoms.

Migration of a sewing needle foreign body into the brainstem of a cat

CASE SUMMARY

A 1-year-old, female spayed domestic shorthair cat with a 6 week history of upper respiratory signs and a progressive reluctance to move, which culminated in a right-sided hemiparesis, was found to have a sewing needle foreign body lodged in the brainstem. Surgical extraction of the needle was successful and the cat's neurological deficits resolved over the days to weeks following its removal.

RELEVANCE AND NOVEL INFORMATION

This case report describes, to our knowledge, the first reported incidence and management of an ingested sewing needle migrating into the central nervous system of a cat.