Espina de pescado alojada en la glándula tiroides / Fishbone lodged in the thyroid gland

Los cuerpos extraños alojados en la vía aéreodigestiva superior son un motivo de consulta frecuente para el otorrinolaringólogo. Uno de los más frecuentes son las espinas de pescado. En raras ocasiones, éstas migran hacia tejidos adyacentes y generan complicaciones importantes. Presentamos el caso de una paciente que tras la ingesta de pescado manifiesta sensación de cuerpo extraño faríngeo, odinofagia y dolor látero cervical derecho. Dada la ausencia de hallazgos a la exploración física y laringoscópica se realiza una tomografia computarizada cervical, visualizando un cuerpo extraño alojado en la glándula tiroidea. Se interviene mediante cervicotomía media, realizando la extracción de la espina sin complicaciones. El diagnóstico precoz y manejo adecuado es determinante para prevenir complicaciones en estos casos.

Foreign bodies in the aerodigestive tract are commonly confronted in otolaryngology practice. The most frequent are the fish bones. In rare cases they can move and cause numerous complications. We report the case of a patient that manifest the sensation of pharyngeal foreign body, after fish ingestion. She also referred odynophagia and right cervical pain. Physical and laryngoscopic examination were normal. A cervical CT was performed, where a foreign body lodged in the thyroid gland was visualized, median cervicotomy was done and the foreign body was extracted. Early diagnosis and adequate management are crucial to prevent complications in these cases.

Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

ABSTRACT A healthy 37 - year - old woman referred to our clinic with one - year history of recurrent urinary tract infection, dysuria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications. On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J - hook monopolar electrocautery and extracted it completely with gentle traction. This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.

Colocación de Endobutton intraarticular posterior a plástica de ligamento cruzado anterior / Intra-articular migration of Endobutton fixation following ACL reconstruction

La ruptura del ligamento cruzado anterior es una patología frecuente en deportistas, siendo la reconstrucción del mismo uno de los procedimientos más frecuentes en la cirugía ortopédica. Se han descripto múltiples técnicas quirúrgicas, con distintos injertos y sistemas de fijación. Si bien la fijación femoral es controvertida, el sistema de fijación suspensoria con Endobutton demostró tener una fuerza biomecánica mayor que la de los tornillos interferenciales. La migración intraarticular del Endobutton es una complicación infrecuente que ha sido descripta previamente en la literatura. Presentamos el caso de un paciente masculino de 24 años de edad, con una migración intraarticular del Endobutton posterior a una plástica del ligamento cruzado anterior de cuatro meses de evolución

The anterior cruciate ligament (LCA) ruptures are a frequent pathology in athletes, being the reconstruction one of the most frequent procedures in orthopedic surgery. Many surgical techniques have been described, with different grafts and fixation systems. Although femoral fixation is controversial, the suspensory fixation system with Endobutton have demonstrated a greater biomechanical force in comparison with interferential screws. The intra-articular migration of Endobutton is an infrequent complication that has been previously described in the literature. We present a 24 years male patient, with an intraarticular migration of the Endobutton posterior LCA reconstruction of four months of evolution. Two stage revision ACL reconstruction were performed modifying the fixation method to a bone patellar bone graft

Embolization by Bullet Dislodged from the Heart

Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.

Stent-graft relining in a patient with acute aortic aneurysm and a completely migrated endograft

Abstract Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was treated by placing a second modular endograft within and above the migrated stentgraft. The patient returned 36 months later, with features of an acute myocardial infarction, severe bilateral lower limb ischemia, and renal failure. He was too ill for intervention and demised within 48 hours.

Anterior minithoracotomy: a safe approach for surgical asd closure & asd device retrieval

Abstract Objective: Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect. Methods: Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy. Results: Twelve patients operated through minithoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6±0.5 days and 7.1±2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication. Conclusion: Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.

Abscesso hepático polimicrobiano por perfuração gástrica por corpo estranho / Polymicrobial hepatic abscess due to gastric perforation by foreign body

Abscesso hepático piogênico é uma condição incomum, com incidência inferior a 1% das internações hospitalares. O abscesso hepático causado por corpo estranho é uma condição extremamente rara, com possibilidade de desfecho fatal devido às dificuldades em se estabelecer o diagnóstico. Relata-se o caso de uma paciente de 52 anos, feminina, com dor abdominal difusa há 1 semana em epigástrio e hipocôndrio direito, associado a diarreia e vômitos há 5 dias e febre de 40°C. Apresentava abdome doloroso, leucocitose de 17.000 p/mm³, bilirrubina total elevada à custa de fração direta, sorologias para HIV 1 e 2 e Hepatite B e C negativas. Em ultrassonografia de abdome total, demonstrou-se imagem heterogênea de 78x61mm em segmento II e III. Na tomografia computadorizada de abdome total observou-se imagem hipodensa, hipovascular, medindo 100x81x78, em lobo hepático esquerdo. Iniciou-se antibioticoterapia empírica e realizou-se drenagem percutânea guiada por ultrassom, demonstrando infecção polimicrobiana em cultura do material. Em ultrassonografia de controle, permanecia área heterogênea, medindo 77x72x49mm em lobo hepático esquerdo. A paciente então foi submetida à laparotomia exploratória, evidenciando no intraoperatório adesão do estômago a parede posterior do fígado. Após descolamento da estrutura, observou-se corpo estranho representado por espinha de peixe no interior do parênquima hepático, oriundo de perfuração da parede anterior do estômago. Embora seja uma etiologia rara, a hipótese diagnóstica de corpos estranhos deve ser considerada em todo caso de abscesso hepático refratário ao tratamento habitual, a fim de reduzir a morbidade e mortalidade do quadro (AU)

Pyogenic hepatic abscess is an uncommon condition, with incidence below 1% of hospitalizations. Hepatic abscess caused by foreign body is an extremely rare condition, with the possibility of fatal outcome due to difficulties in establishing the diagnosis. Here the authors report the case of a 52-year-old female patient with diffuse abdominal pain for one week in the epigastrium and right hypochondrium associated with diarrhea and vomiting for 5 days and fever of 40 °C. She presented painful abdomen, leukocytosis of 17,000 p/mm³, elevated total bilirubin at the expense of direct ratio, and negative serologies for HIV 1 and 2 and Hepatitis B and C. In total abdomen ultrasound, a heterogeneous image of 78x61mm was shown in segment II and III. Computed tomography of the total abdomen showed a hypodense, hypovascular image, measuring 100x81x78mm, in the left hepatic lobe. Empirical antibiotic therapy was initiated and ultrasound-guided percutaneous drainage was performed, demonstrating polymicrobial infection in culture of the material. In control ultrasonography, a heterogeneous area remained, measuring 77x72x49mm in the left hepatic lobe. The patient was then submitted to exploratory laparotomy, with intraoperative evidence of adhesion of the stomach to the posterior wall of the liver. After detachment of the structure, we observed a foreign body represented by fishbone inside the hepatic parenchyma, originating from perforation of the anterior wall of the stomach. Although it is a rare etiology, the diagnostic hypothesis of foreign bodies should be considered in all cases of hepatic abscess refractory to usual treatment, in order to reduce the morbidity and mortality of the condition (AU)

Dispositivo intrauterino parcialmente migrado e incrustado en serosa de rectosigmoides tras 8 años de inserción / Partially migrated intrauterine device embedded in the rectosigmoid serosa after 8 years of insertion

Se presenta el caso clínico de un dispositivo intrauterino parcialmente migrado a cavidad pélvica e incrustado en serosa de rectosigmoides luego de 8 años de su inserción. El diagnóstico se realizó mediante ecografía transvaginal y retiro del dispositivo por laparoscopia. Se realizó rafia de serosa rectal y de útero. La paciente tuvo un postoperatorio sin complicaciones.

It is shown the clinical case of an intrauterine device partially migrated to the pelvic cavity and embedded in the serous rectosigmoid eight years after insertion. The diagnosis was made by transvaginal ultrasound and laparoscopy removal of the device by laparoscopy. Suture of rectum serous and uterus were performed. The patient had an uneventful postoperative course.

Migration of Long Standing Fish Bone to Subcutaneous Tissues of the Neck: An Unusual Presentation.

Fish bone is one of the most common foreign bodies encountered in the upper aerodigestive tract region. Owing to its trivial size, smooth surface, and sharp ends, it has a great propensity to migrate in the neck and adjoining structures. Long standing migrated foreign bodies can cause devastating complications like neck abscess and injuries to the major blood vessels. Herein, we report a rare case of long-standing fish bone, which migrated to the subcutaneous tissues of the neck. The foreign body bypassed all the vital structures and was observed as a projection in the skin of the patient’s neck. A careful history and a detailed clinico-radiographic investigation helped to locate the bone and aided in its successful removal.

Dispositivo intrauterino migrado a la cavidad abdominal con embarazo intrauterino no evolutivo: reporte de caso / Intrauterine device migrated to the abdominal cavity with non-progressive intrauterine pregnancy: case report

La migración de un dispositivo intrauterino a la cavidad abdominal es una complicación poco frecuente de este eficaz método contraceptivo, sin embargo debe sospecharse ante la imposibilidad de visualizar los hilos del dispositivo vía vaginal y la ausencia intrauterina del mismo por ecografía. Si bien la migración abdominal puede ser asintomática, algunos casos pueden producir clínica de severidad variable incluyendo dolor abdominal y complicaciones derivadas de la formación de adherencias o la perforación de vísceras pélvicas y abdominales. Su detección intraabdominal debe sospecharse en primer lugar por ecografía y confirmarse mediante radiología simple de abdomen. Una vez localizado el dispositivo migrado, se recomienda su extracción inmediata, incluso en casos asintomáticos, con el fin de evitar las complicaciones derivadas de su desplazamiento. La laparoscopia será de primera elección en estos casos para la extracción. Presentamos un caso de migración intraabdominal de dispositivo intrauterino concurrente a un embarazo intrauterino no evolutivo.

Migration of an intrauterine device to the abdominal cavity is a rare complication of this effective contraceptive method, however, it must be suspected upon the inability to visualize the wires vaginally and the absence of intrauterine device by ultrasound. While its abdominal migration can be asymptomatic, some cases may produce variable clinical severity including abdominal pain and complications resulting from the formation of adhesions or perforation of pelvic and abdominal viscera. Its intraabdominal detection should be suspected first by ultrasound and confirmed by plain abdominal X-ray. Once the migrated device is located, immediate removal is recommended, even in asymptomatic cases, in order to avoid complications arising from its displacement. Laparoscopy will be the first choice in these cases for extraction. We report a case of intraabdominal migration of intrauterine device concurrent with a non-evolutive intrauterine pregnancy.

Intraoperative localization and monitoring of migrating foreign body using transesophageal echocardiography.

Radiological imaging is often used for the preoperative localization of foreign body following blast injury, but their utility in case of migration during intra‑operative period is limited. Transesophageal echocardiography (TEE) has been used for intra‑operative localization and removal of intra‑cardiac foreign body; however, reports for localization of extracardiac migrating foreign body are few. Preoperative radiological imaging, in a victim of factory blast‑injury, suggested foreign body in the posterior mediastinum. However, the intra‑operative TEE showed it in the left atrium, which later migrated into the left ventricle necessitating a change in surgical approach for its removal.

Percutaneous endovascular removal of intracardiac migrated port A catheter in a child with acute lymphoblastic leukemia / Remoção endovascular percutânea de cateter totalmente implantável com migração intracardíaca em criança com leucemia linfoblástica aguda / Retirada por vía intravenosa percutánea de catéter Port-A debido a la migración intracardiaca en niño con leucemia linfoblástica aguda

A 2-year-old boy with acute lymphoblastic leukemia was presented with peripherally inserted central catheter dysfunction. Radiological examinations revealed a catheter remnant in the right atrium extending into pulmonary vein. The catheter remnant was successfully removed from the right atrium by percutaneous endovascular intervention without any complications.

Menino com dois anos de idade com leucemia linfoblástica aguda foi apresentado com disfunção de cateter central perifericamente inserido. O exame radiológico revelou um fragmento do cateter no átrio direito que se estendia até a veia pulmonar. O fragmento foi removido com sucesso por intervenção endovascular percutânea, sem qualquer complicação.

Paciente del sexo masculino, de 2 años de edad, con leucemia linfoblástica aguda que se presentó con una disfunción del catéter central de inserción periférica. Los exámenes radiológicos acusaron un resto de catéter en la aurícula derecha, extendiéndose hacia la vena pulmonar. El catéter fue retirado con éxito de la aurícula derecha por vía intravenosa percutánea sin complicaciones.

Dispositivo anticonceptivo intraovárico. Presentación de caso / Intraovaric anticonceptive device. Case presentation

Fundamento: los dispositivos intrauterinos no están exentos de complicaciones y al igual que cualquier otro cuerpo extraño implantado en el organismo puede migrar a otra región. Presentación de caso: paciente femenina con antecedentes de implantación de un dispositivo intrauterino (T de cobre) en su área de salud hace seis meses, acude al servicio de cirugía refiriendo dolor intermitente en fosa iliaca izquierda y bajo vientre de varios meses de evolución, además de proctodinia. En el ultrasonido abdominal y ginecológico no se observó la presencia del dispositivo intrautero pero sí hacia la proyección anexial izquierda, en el rayos x de pelvis antero posterior se comprobó la imagen radiopaca del dispositivo intrauterino hacia fosa ilíaca izquierda. Conclusiones: se intervino quirúrgicamente encontrándose dispositivo intrauterino de localización intraovárica y trompa de Falopio de ese lado inflamada y adherida al ovario, realizándosele salpingectomía y ooforectomía izquierda. La paciente evolucionó favorablemente sin complicaciones postoperatorias, se egresó a los cinco días después de terminado el tratamiento antibiótico de la sala de cirugía.

Background: the intrauterine devices are not exempt of complications and as any other foreign body implanted in the organism can migrate to another area. Case presentation: a female patient with a history of an implant of an intrauterine device (copper T) in her health area six months ago comes to the surgery service with an intermittent pain in the left iliac fossa and low abdomen with several months of evolution, besides proctodinia. In the abdominal and gynecological ultrasounds there was no presence of the intrauterine device but towards the left iliac fossa. Conclusions: She had a surgery, finding the intrauterine device of intraovaric and pallopian's tube of that swollen and adhered side to the ovary, carrying out left salpingectomy and oophorectomy. The patient evolved favorably without post-operatory complications. She was released five days after finished the antibiotic treatment of the surgery ward.

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy.

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.