Ultrasound-Guided Percutaneous Removal of Foreign Body Using Hydrodissection and Serial Dilators / 대한정형외과학회잡지

High-resolution ultrasound of the painful, swollen left heel of a 54-year-old man, who reported that his symptoms had lasted 4 months, showed retention of a wooden foreign body in the heel. After administering local anesthesia and making a 5-mm skin incision, we performed hydrodissection of the foreign body from the adjacent soft tissue under real-time ultrasound guidance, using a 1% lidocaine solution. Then, we introduced an 18-gauge spinal needle and inserted a guide-wire through the needle. After we removed the needle, we introduced serial dilators in sizes ranging from 7 French to 12 French along the guide-wire to create a tract for mosquito forceps. Then, we introduced the mosquito forceps and removed the wooden foreign body. Ultrasound-guided percutaneous removal of foreign bodies is quick and safe. We believe that hydrodissection makes removal easier and that use of serial dilators minimizes soft-tissue injury and makes it easier to introduce mosquito forceps.

Percutaneous Removal of Spilled Gallstones after Laparoscopic Cholecystectomy

Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs frequently, but clinical sequelae caused by dropped gallstones are uncommon. We present a case of subhepatic and right-back abscess formation due to spilled gallstones occurring two years after LC, which were successfully removed using a percutaneous method as a minimally invasive technique. The patient firstly visited a primary care physician with right-back mass that was increasing in size and becoming symptomatic, then underwent incision and drainage. He was referred to our hospital and the subhepatic and right-back inflammatory mass containing spilled gallstones was revealed by computed tomography. Under fluoroscopic control, a percutaneous drainage catheter was placed within the abscess and pus was aspirated. The spilled gallstones were successfully retrieved with basket forceps, thereafter. The patient was discharged without significant complications on the 9th day after the percutaneous stone removal.

Percutaneous heartworm removal from dogs with severe heart worm (Dirofilaria immitis) infestation

Canine heart worm disease is often life-threatening due to its various complications, including right side heart failure, caval syndrome and pulmonary eosinophilic granulomatosis. Several preventive medications and melarsomine have been developed and they are very effective to control heartworm infestation. However, in a case of severe infestation, melarsomine therapy often results in an unfavorable outcome because of the severe immune reaction caused by rapid killing of the adult worm. Surgical removal and an interventional method using flexible alligator forceps have been well described in the literature. Despite the usefulness of mechanical removal using flexible alligator forceps, the methodology still needs to be upgraded for increasing the applicability for treating dogs with severe infestation. We describe herein a newly developed percutaneous removal method for heartworms and this was successfully applied to 4 dogs with severe heartworm infestation. The follow-up studies also showed favorable outcomes with no complications.

Kirschner Wire Migration to the Cervical Spine: AComplication of Clavicular Fixation in a Child

We report a case of a broken K wire migrating to the cervical spine from the right clavicle in a 9 year old child. The initial diagnosis, fracture of the clavicle with an acromioclavicular joint dislocation, was treated by open reduction and K wiring. One K wire broke and migrated to the neck, posterolateral to the C6 vertebra. The K wire was removed percutaneously under image intensification. Acromioclavicular joint dislocation in children is rare since the distal clavicle does not ossify until the age o

Complete Fracture of Totally Implantable Venous Catheter / 대한흉부외과학회지

The patient was a 42-year-old female with breast cancer who had an implantable central venous catheter inserted percutaneously into left subclavian vein for chemotherapy. The postinsertion chest x ray revealed that there was no compressive sign of catheter. Three months after insertion of the catheter, the patient was admitted to the hospital for 4th chemotherapy. The port was accessed but blood could not be aspirated and the catheter could not be flushed. A chest x ray revealed that the catheter was completely transected at the point where the catheter passed under the clavicle. Percutaneous removal of the distal fragment of the catheter was accomplished. The patient was discharged after successful removal of fragment of catheter.