Proximal migration of retained pencil lead along a flexor tendon in the hand

Abstract

Rationale:The hand is the most common site for foreign body injuries. Pencil lead penetration mainly occurs in school-age children.We report a case of proximal migration of a retained pencil lead in the hand, emphasizing the importance of adequate imaging and prompt removal of the foreign body.Patient concerns:We report the case of an 8-year-old boy who visited our outpatient clinic for a retained foreign body in the right palm. Removal was planned under general anesthesia. Black staining from the pencil lead was observed around the tendon sheath in the operative field, but the foreign body itself was not apparent.Diagnosis:Intraoperative radiography located the foreign body at the wrist, 5 cm away from the original site. Proximal migration of the retained foreign body was suspected.Intervention:Incision was extended toward the wrist and the foreign body was discovered in the flexor sheath at the wrist.Conclusion:Foreign bodies may migrate to adjacent tissues, but rarely wander far. Computed tomography is the most useful tool in diagnosing a pencil lead foreign body.Lessons:Adequate imaging and prompt removal of the foreign body is important. When a retained foreign body is removed after a delay, the physician must always consider the possibility of foreign body migration.