Laparoscopic Removal of an Ingested Needle, which was Penerated to the Lesser Omentum of the Stomach

The perforation and migration of ingested sharp metallic bodies is a rare event. A perforation of the gastrointestinal tract is difficult to accurately and quickly diagnose when there is no peritonitis or abscess formation. Patients often present with no symptoms. The discovery of a foreign body on a radiological examination of the abdomen may be made incidentally. Moreover, a history of ingestion is usually difficult to obtain. Foreign bodies after perforation have been reported to migrate to any intra-abdominal site and to extra-abdominal sites in rare cases. We report one case of young man with ingested needle in which perforated silently and migrated to the lesser omentum. A 23-year-old man presented with an incidental foreign body. He has no definite ingestion history or psychiatric disorder, but was a heavily drinker. An abdominal plain X-ray showed a needle in the upper abdominal area. Computed tomography revealed the foreign body to be located beneath the liver and in the lesser omentum. The patient underwent a laparoscopic examination performed in the supine position. After creating a pneumoperitoneum by CO2 gas insufflation at 12 mmHg, 3 trochars (two 5-mm and 12-mm) were introduced at each subcostal and supraumbilical area. Surgical management using laparoscopic extraction was successful. The patient was discharged in good health on the 3rd day after the procedure. Laparoscopy can be used to remove ingested foreign bodies when surgery is indicated.

Splenic Abscess Arising from a Dental Abscess in Healthy Man

Isolated splenic abscess of spleen is very rare, which is increasingly recognized with immunosuppressed states due to the use of chemotherapy to malignancy, immunosuppression for transplantation and AIDS recently. The most fre-quent cause of splenic abscess is septic embolism arising from bacterial endocarditis. While splenic abscess can be seen rarely in healthy men, it has a high rate of mortality when it is diagnosed lately. A healthy 66-year-old male patient who presented with a 7 month history of intermittent spiking fever, toothache was admitted to the emergency room with clinical and biochemical signs of sepsis. Vital sign were 90/60-112-20-38.9 degrees C. He had left subcostal tenderness, a 15 cm palpable spleen and no medical history except toothache. The laboratory values were as follows: leukocyte 289,200/mm(3)(segmented neutrophil 94.3 %), hemoglobin 10.5 g/dl, platelet 119,000/mm(3), AST/ALT 85/84 U/L, total bil-irubin 10.8 mg/dl, BUN/Creatinine 25/1.3 mg/dl. Streptococcus viridians grew in blood culture. Computerized tomography showed a splenomegaly with multifocal round or tubular shaped cystic lesions in spleen as well as infiltrative low density lesions in pancreatitic taie like intrasplenic pseudocysts, which was failed by ultrasound-guided aspiration due to multiple, small and scattered location. Echocardiography showed no evidence of intracardiac source of infective thromboembolism. Endoscopic retrograde cholangiography shows mild intrahepatic duct and common bile duct dilataton with no evidence of stone. Exploratory laparotomy was performed. The spleen being found enlarged and distal pan creas with probably pseudocystic involvement were removed. It was also noticed that there were cystic-like structure filled with pus on crosssectional surface. The result of pus cultures was no organism.