Foreign body: A sewing needle migrating from the gastrointestinal tract to pancreas

Abstract

Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery. Keywords: Sewing needle, pancreas, laparoscopy INTRODUCTIONOut of all the ingested foreign bodies, 43.7% are organic, 56.3% are inorganic, and 2.4% are sewing needles. Most of the ingested foreign bodies are excreted spontaneously (1). These foreign bodies may reach pancreas and liver in 1% of patients, through penetration of small intestine or stomach wall (1, 2). Foreign bodies in pancreas might cause serious complications such as pancreatitis, pancreatic abscess, and pseudoaneurysm. These should be removed either endoscopically or surgically (1, 3, 4). In few cases, foreign bodies can also be removed using open surgical techniques (2, 5). However, the suggested technique is the laparoscopic approach before open surgery (3, 6, 7). Here we report the case of a 23-year-old female patient, who presented with epigastric pain and a sewing needle was removed laparoscopically from her pancreas parenchyma. CASE PRESENTATIONA 23-year-old female patient presented with epigastric pain and retrosternal burns that continued intermittently for seven years. She had used proton pump inhibitors (PPI) and as her symptoms did not resolve, she presented to the hospital. In her physical examination, there was minimal tenderness and discomfort in the epigastric area without rebound sign or defense. Laboratory blood tests including her hemogram, biochemical markers, liver function tests, kidney function tests, and amylase levels were within normal limits. Her standing abdominal x-ray was also normal ( Figure 1a). During gastroscopy, no sign of any pathology related to a foreign body was observed. We performed a barium follow-through x-ray with an initial diagnosis of gastroesophageal reflux disease, and in this test, we observed a foreign body in the epigastric area (Figure 1b). When patient's medical history was questioned again, it was found that she had accidentally swallowed a sewing needle seven years ago. She underwent computed tomography screening and we saw that a foreign body was present starting from the posterior side of the stomach reaching head and body of the pancreas. (Fig...

Successful laparoscopic treatment for sustained abdominal pain due to fish bone migrating into the neck of the pancreas: a case report and thinking about surgical approach through the literature review

“…Compared with cases underwent open surgery, their postoperative day discharge was significantly shorter, as shown in Table 2. Therefore, laparoscopic approach should be preferred especially in this series, due to its advantages of less postoperative pain, lower incidence of wound infection, and minimal surgical stress [21].…”

Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature

“…Since many foreign bodies migrate to the pancreas, a laparoscopic approach may be beneficial over open procedures because it allows the surgeon to approach the lesser sac with minimal manipulation of surrounding tissues while being aided by optimal magnification and illumination [ 2 ]. For diagnosed abdominal foreign body extraction, laparoscopic approach should be preferred especially in stable nonacute patients, because of its advantages of less postoperative pain, lower incidence of wound infection, and minimal surgical stress [ 3 ]. In the present case, we first attempted to remove the foreign body endoscopically, but failed because it was not detected.…”

“…Fish bone is an ingested foreign body which can perforate through the wall of stomach or duodenum and migrate to other surrounding organs like the pancreas and liver [ 2 ]. Many life-threatening complications like pancreatitis, pancreatic abscess and pseudoaneurysm can be occurred, when a foreign body reach pancreas [ 3 ]. There are very few reported cases in which an ingested foreign body penetrated the gastrointestinal tract and migrated into the head of the pancreas.…”

Abdominal skin inflammation as an initial symptom of a perforating gastric foreign body

“… [3] Accidental ingestion of a foreign body most commonly occurs through the mouth or pharynx, followed by the gastrointestinal tract. [4] Rarely, these objects migrate from the digestive tract to the pancreas, [5] or the liver to cause liver abscess, [6] or they penetrate the pharynx to the surface of the skin. [4] The fishbone is one of the most common accidentally ingested dietary foreign bodies, accounting for up to 84% of all foreign bodies ingested accidentally.…”