Intrarenal foreign body presenting as a renal calculus

Migration of a Hem-o-Lok clip to the renal pelvis after laparoscopic partial nephrectomy: A case report

BACKGROUND

Hem-o-Lok clip (HOLC) has been widely used in laparoscopic surgery due to its ease of application and secure clamping, though the rare complications associated with this technique should not be ignored. The rare complications of laparoscopic partial nephrectomy consist of the clip migrating into the renal pelvis and acting as a nidus for stone formation.

CASE SUMMARY

The case described here involved a 63-year-old woman who was found with stones in the right kidney and upper ureter during a recent reexamination following laparoscopic partial nephrectomy. We performed percutaneous nephrolithotomy for her, but during the operation, it was found that the center of the stone within the kidney was a HOLC, which was removed with forceps. For this reason, we speculate that the HOLC, which was employed to halt tumor wound bleeding, spontaneously drifted into the renal pelvis and formed kidney stones, with the clip being initially misdiagnosed as a kidney stone.

CONCLUSION

By reviewing related case reports, we conclude that in order to prevent complications related to HOLC, loose clips should be actively searched for and retrieved from the wound during urinary tract surgery, while the deployment of clips in close proximity of anastomotic stoma of collecting systems should be avoided.

Electric wire as a urethral foreign body: A case report

RATIONALE

Most self-insertion of urethral foreign bodies is the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Ultrasound has been proven to be an effective tool for determining the presence, location, and characteristics of the urethral foreign body.

PATIENT CONCERNS

A 48-year-old man presented with a mass in the urethra for 2 years. Physical examination suggested swelling and ulcer in the scrotum. The white blood cell count was elevated (12.60 × 109/L). Urinalysis showed an increased white cell count (484.60/μL) and urine occult blood (±).

DIAGNOSIS

Ultrasound examination of the genitourinary system identified an 8.3 cm linear hyperechoic object and hyperechoic spots in the urethra. Computed tomography revealed an extremely hyperdense lesion in the penis. Intraoperative findings showed electric wire bending and winding surrounded by fibrous tissues with urethral rupture.

INTERVENTIONS

The patient was treated with urethrotomy as the endoscopic treatment failed. and the electric wire was removed successfully.

OUTCOMES

The patient was followed up for 45 days without discomfort. Ultrasound examination of the genitourinary system suggested that the wound was almost healed, but with a small urethral effusion, with a maximum depth of approximately 1.9 mm.

LESSONS

A foreign body was inserted into the patient's urethra for 2 years without any medical treatment. Urethral perforation was found during surgery. In such cases, ultrasound examination can determine the location, shape, and size of the urethral foreign body and play an important role in the diagnosis of foreign bodies.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 2. Intracorporeally-Retained Urological Surgical Items

OBJECTIVE

Presentation of our center's experience in the management of intracorporeally-retained urological surgical items.

MATERIALS AND METHODS

Retrospective search of our center's data for cases of retained surgical items during the period July 2006 to June 2016. Each case was studied for the demographic and clinical variables including types, presentation, and management.

RESULTS

Out of more than 55,000 different urological interventions, only 39 cases (28 males and 11 females) had retained surgical items. Urolithiasis-related urological subspecialties were more involved than others. Forgotten items and technically-retained items occurred in 38.5 and 61.5% of cases, respectively, and were immediately discovered or discovered up to 10 years later. Material types were textiles, biosynthetics, and metallics in 31, 51, and 18%, respectively. Possible predisposing factors included complex surgeries, emergent intraoperative events, and extra approaches. Occurrences of retained surgical items before and after implemented corrective actions were 74.6 and 25.4%, respectively. All the final outcomes were either short- or long-term harm without deaths, organ losses, or permanent disabilities.

CONCLUSION

Retained urological surgical items are surgical never events that result from forgetfulness or technical surgical human errors. Their sequels can be potentially fatal, but they are preventable and can be significantly reduced.

Foreign body mimicking neoplasia of the renal pelvis on magnetic resonance imaging

A 65-year-old male presented with an incidental magnetic resonance imaging (MRI) finding of a right renal pelvis (RP) tumor-like mass. He was subjected to nephrostomy tube (NT) placement due to hydronephrosis secondary to an impacted ureteral stone. NT was removed after successful Ho:YAG laser lithotripsy. Abdominal MRI performed 19 months later for another indication showed RP wall thickening/enhancement and an intrapelvic low-intensity linear structure presenting as a magnetic susceptibility artifact. He underwent diagnostic ureterorenoscopy/retrograde intrarenal surgery. A calcified NT locking suture remnant was found within the pelvis surrounded by reactive edema without evidence of tumor. Foreign body (FB) was removed after disintegration of surrounding calcifications using Ho:YAG laser. This is the first case of a calcified NT locking suture remnant mimicking RP tumor on MRI. The case underlies the importance of safe NT removal. Specific MRI findings may prove valuable for preoperative diagnosis of intrarenal FBs in cases with history of endourological interventions evaluated for upper urinary tract masses. Multidisciplinary-uroradiological approach of such cases is essential.

Breast Textiloma: An unending medico-legal issue about a case report

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Forgetting sponges in the breast after surgery is uncommon and may mimic a recurrent tumor after years.

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Medico-legal implications are heavy which jeopardize the reputation of the surgeon.

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The patient was not informed about the real diagnosis because of fear of litigation.

Introduction

Textiloma is a mass composed of retained surgical textile foreign body. It is a rare iatrogenic complication that can engage the doctor’s responsibility. The aim of this manuscript is to report an unusual case of breast Textiloma mimicking a recurrent tumor and to highlight its medico-legal implications.

Presentation of case

A 47-year-old lady, without past medical history, was diagnosed with a breast infiltring intraductal carcinoma. She was treated with mastectomy. Four years later, the patient consulted her surgeon for a subcutaneous mass in the operative site. Both medical and radiological investigations concluded to recurrent tumor. Histological examination confirmed the diagnosis of Textiloma.

Discussion

Retained foreign bodies in the operative site are infrequent but serious iatrogenic complications. Clinical manifestations of Textiloma are variable and non-specific. It should be suspected in any postoperative case with unresolved or unusual problems. It can mimic other conditions such as tumor. Textiloma is a frequently injurious situation that can lead to medico-legal implications. It is considered to be a sample of medical negligence that involves the surgeon responsibility.

Conclusion

Textiloma is a preventable condition and it can be avoidable by maintaining standard recommendations.