Intra-abdominal insertion of sewing needles: a rare method of child abuse

An unusual case of gastrointestinal perforation caused by trans-abdominal penetration of sewing needles

Trans-abdominal penetration by foreign bodies causing bowel injury is uncommon. We present a case of injury to the caecum caused by deliberate trans-abdominal placement of hand sewing needles. The patient was managed successfully by urgent laparotomy with right hemicolectomy and primary anastomosis.

Fabricated or induced illness in twins associated with insertion of trocar needles into their bodies

Fabricated and/or induced illness (previously known as Munchausen syndrome by proxy) is a form of child abuse in which the perpetrator induces, exaggerates or fabricates illness in his/her child. Two-month-old twins were referred to the paediatric surgery centre with trocar needles lodged in different organs. A radiograph undertaken in one of them because of acute respiratory distress demonstrated needles in the heart and diaphragm which were removed surgically. The second twin, referred one week after his brother, had a needle deep in his liver and it was decided not to operate owing to the possibility of haemorrhage but, sadly, he died unexpectedly and the autopsy concluded that it was owing to sudden infant death syndrome. Because of a number of admissions to different units in the same hospital, there was a delay in the eventual diagnosis. Recurrent admissions to different hospital units should raise the suspicion of fabricated and/or induced illness.

Sewing needles in the lungs of children: Two case reports

RATIONALE

Foreign bodies are common in children. However, it is uncommon to have a "sewing needle" penetrating the body percutaneously rather than via a natural orifice. Such cases have been reported from across the world, with needles being found in regions such as the cranium, abdomen, limbs, neck, scrotum, and buttocks. Few cases with a needle inserted in the lung have been reported.

PATIENT CONCERNS

We present 2 cases where the needles were found in the chest wall/lung because of suspected child abuse. In the first case, foreign bodies were present in the chest wall and the lung. In the other case, the pointed end was oriented towards, and was very close to, the great arteries.

DIAGNOSES

Both cases were diagnosed incidentally when chest X-ray was being performed for other reasons.

INTERVENTIONS

Surgery was indicated for both cases, and the needles were excised uneventfully.

OUTCOMES

The postoperative course in both cases was uneventful.

LESSONS

It is worth noting that in both cases, neither the guardians nor the victims themselves could tell when and how the needles got lodged in the lungs. Collective information suggested that these 2 cases probably involved child abuse. Child abuse in China has long been underestimated and underrecognized. There is still much left to do to tackle this important issue, especially in rural areas.

Laparoscopic retrieval of unusual intra-abdominal foreign bodies in children

Foreign body (FB) ingestion is a common problem among the pediatric population. On numerous occasions, the FB is left to pass out spontaneously without expecting any harm. There are instances when the FB is either to dangerous to be left alone, that is a button battery or a sharp object. There may be FB, which is either stuck in GIT or have migrated. The situation in these instances demand active intervention. The traditional option has been laparotomy and retrieval. We present here three cases where two needles and a belt buckle were removed by laparoscopy thus avoiding a laparotomy. These cases prove that laparoscopy should be the first choice for such kind of retrieval. These cases had a successful outcome with full recovery.