PMC4909132_01
Multiple midline and left paramedian surgical scars with enterocutaneous fistula in lower abdomen.
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Excessive scar tissue and enterocutaneous fistula were observed in her lower abdomen (Fig. 1).
X-ray shown multiple radiopaque long thin objects disseminating throughout the abdomen.
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The abdominal X-ray (Fig. 2) and CT scan (Fig. 3) showed multiple metallic bodies disseminating throughout the digestive tract.
Axial, sagittal and coronal image shown needle penetrating from the posterior wall through the body of the pancreas.
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One needle was reported penetrating the posterior gastric wall to the body of the pancreas (Fig. 4).
Needles were found freely penetrating the intestine wall during the operation.
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There were 3 needles found freely penetrating from the small intestine (Fig. 5).
Pathological findings. Jejunum containing the enterocutaneous fistula was resected. The total length of removed jejunum was 100 cm. There were 5 needles found inside the lumen of resected intestine.
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Pathology report confirmed 5 needles intraluminally and one needle embedded in the muscular layer with sign of severe peritonitis (Fig. 6, Fig. 7).
Small gastrotomy (star mark) was created at the mid anterior gastric wall, but no needle was visualized nor palpated. The yellow arrow shown the tip of the needle fully migrating from the posterior gastric wall toward the body of the pancreas. Most of the needle was buried inside the pancreatic parenchyma. Great care was taken to extricate the whole intact needle from the pancreas without additional pancreatic resection.
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The tip of needle was found protruding from the body of pancreas and the whole needle was extricated unremarkably without additional resection of pancreas (Fig. 8).
Abdomen X-ray one year ago shown the same shape and size of the radiopaque object located at the left lower abdomen, which suggested the firm fixation of the needle to the abdominal wall.
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Not only because it was unchanged for the last 2 years compared to previous X-ray (Fig. 9), but also in the concern of ventral hernia due to tremendous abdominal wall exploration to remove the foreign body.
Intraoperative abdomen X-ray shown no needle in the digestive tract.
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We confirmed no needle left inside the digestive tract using C-arm fluoroscopy intraoperatively (Fig. 10).