Laparoscopy treatment of liver abscess secondary to an unusual foreign body (rosemary twig)

A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.

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)

Duodenal gossypiboma: a case report and literature review / Gossypiboma duodenal: reporte de un caso y revisión de la literatura

Gossypiboma is a retained surgical cotton matrix material in the body after a surgical procedure. Cases are rarely reported due to medico-legal concerns. Although infrequent, it causes serious morbidity and even mortality if left undiagnosed. We present the case of a trans-mural migration of gossypiboma and a review of the literature. Gossypiboma’s trans-duodenal migration is a rare complication of retained gauzes. Cases reported in the literature were easy to diagnose based on clinical grounds and endoscopic studies.

La palabra gossypiboma define una gasa o matriz de algodón retenida en el organismo después de un procedimiento quirúrgico. Se reportan con poca frecuencia debido a las implicaciones médico-legales. A pesar de ser poco frecuentes, pueden ser causa de morbilidad si no se diagnostican. En el presente trabajo se reporta un caso de un gossypiboma con migración transduodenal. La migración transduodenal de un gossypiboma es una complicación rara que suele diagnosticarse sin dificultad con base a la clínica y a la endoscopía.

Migrating ingested foreign body of the upper aerodigestive tract with resultant septic shock: case report and literature review

Complications due to foreign body ingestion are rare; however, if present, these can cause significant morbidity to the patient. An overlooked ingested foreign body could present as an emergency and may prove fatal. We present a case of an accidentally ingested foreign body with delayed presentation, which migrated to the neck and produced a cervical abscess presenting as septic shock. The patient required prompt stabilisation followed by surgical intervention. The patient's vital signs returned to normal on the second post-operative day, and he was discharged the following day

Migration of a sirolimus-eluting stent from the ostium of the left main coronary artery to the right deep femoral artery

No abstract available.

Intracardiac foreign body caused by cement leakage as a late complication of percutaneous vertebroplasty

No abstract available.

Surgical Treatment for Intra-Thoracic Migration of Acupuncture Needles

The aim of this study was to introduce the experience of diagnosis and treatment for patients with migrated acupuncture needle to pleural cavity and or lung parenchyma. We had treated 5 patients who had acupuncture needles in their thoracic cavity from January 2000 to September 2009. The mean age was 55.8 yr old. All patients suffered from the sequelae of the cerebrovascular accident and had been treated with acupuncture. They had drowsiness and hemiplegic or quadriplegic motor activity. Fever and dyspnea were main symptoms when referred to us. Diagnosis was made by the chest radiography and chest computed tomography which revealed straight metallic materials in their thoracic cavity. The needles were removed via thoracotomy or thoracoscopic procedures. Pleural decortications were also needed in four patients. Thoracoscopic surgery was successfully performed in two patients. After the removal all patients became symptomless. Although we experienced only five patients who have migrated acupuncture needles in thoracic cavity, we suggest that thoracoscopic removal of the needle with or without pleural decortication is the most optimal modality of treatment in those patients.

Fractured tracheostomy tube migrating into the tracheobronchial tree: A rare complication.

Tracheostomy is a life saving procedure and many patients are discharged with permanent tracheostomy tubes. We report the rare occurrence of a fractured tracheostomy tube migrating into the tracheobronchial tree and highlight the clinical manifestations of this uncommon complication that carries the potential risk of fatal respiratory obstruction.

Risk factors for intraocular penetration of caterpillar hair in Ophthalmia Nodosa: A retrospective analysis.

We report risk factors associated with intraocular penetration of caterpillar hair seen at our institute from January 2005 to December 2007. Records of all patients with caterpillar hair induced ophthalmitis (CHIO) were retrospectively reviewed for clinical characteristics, anatomic location of lodgment of the caterpillar hair, treatment methods, and outcomes. Out of a total of 544 cases of CHIO, 19 eyes (seven in the anterior chamber and 12 in the posterior segment) experienced intraocular penetration (3.5%). The presence of deep intracorneal hair (80 cases, 14.7%) was found to be the only risk factor for intraocular penetration (P < 0.001). The removal of intracorneal hair was possible in only 29 out of 80 eyes (36%) and this was associated with a significantly reduced risk of intraocular penetration (P = 0.022). Patients with retained intracorneal hairs should be counseled regarding risk of intraocular penetration and closely followed up for at least six months.

development of migration in laparoscopic adjustable gastric banding and the approach to treatment

Laparoscopic adjustable gastric banding [LAGB] application in the treatment of morbid obesity has many advantages. However, certain complications, such as intragastric migration, may occur. In the present study, the effects of such migration and surgical treatment methods were investigated. One hundred thirty-four patients underwent LAGB via the Pars Flaccida technique. Of the patients mean age was 27 years [18-54]. Migration was suspected based on disappearance of the band-related stricture barium contrast examination of the stomach and duodenum. Migration was definitely diagnosed during gastroscopy. Migration was diagnosed in four [3%] of 134 patients, as well as in one case who underwent LAGB in another center. The follow-up time was 14 months [2-21] and, their mean body mass index [BMI] was 47 kg/m2 [39-56]. The band was removed in four patients, the opening formed in the stomach was sutured primarily. One of the patients underwent cholecistectomy and Roux-en-Y gastroenterostomy [RNYGE]. The development of migration after LAGB is a long-term complication. Gastric bands should be removed as soon as the migration is diagnosed. RNYGE in the same session, or new band application 3-6 months later

Lipoid pneumonia: An uncommon entity.

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.

Corpos estranhos caminham pelo corpo em direção ao coração? / Do foreign bodies migrate through the body towards the heart?

A fixação dos CE, principalmente os pontiagudos, favorece a migração pelo corpo, gerando a expressão popular: "os CEs caminham pelo corpo em direção ao coração". OBJETIVO: Descrever os mecanismos envolvidos na migração do CE e a forma de diagnosticá-los. METODOLOGIA: Numa população de 3.000 casos de corpos estranhos, em 40 anos, foram analisados quatro que tiveram deslocamento extraluminal. Foram tomados os dados clínicos, radiológicos, endoscópicos e ultrassonográficos coletadas no serviço de documentação médica. RESULTADOS: São apresentadas três histórias clínicas em que o CE era de espinha de peixe e uma de cartilagem de peixe. Em todos se analisou o deslocamento. Em dois a migração se iniciou no esôfago, um para a aorta e outro para a região cervical e nos dois outros, o deslocamento ocorreu a partir da faringe: um para a fáscia pré-vertebral e outro se exteriorizou na região submandibular. Discutem os mecanismos pelos quais ocorre a migração dos CEs pelo corpo e os riscos que tais deslocamentos promovem para o paciente e a forma de diagnosticá-los. CONCLUSÕES: Os CE podem caminhar pelo corpo, porém não para o coração. Em casos de histórias arrastadas de ingestão de CEs, o estudo por imagens se faz obrigatório, previamente ao exame endoscópico.

Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: "FB walk to the heart". AIM: describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

Intraluminal migration of Gossypiboma without intestinal obstruction for fourteen years.

A 55 years lady presented with dull aching right upper abdominal pain with intermittent episodes of diarrhea following cholecystectomy which she underwent fourteen years back. Ultrasound and computed tomography findings were suggestive of foreign body in right subhepatic space. Exploratory laparotomy revealed circumvented loop of ileum with intra luminal mass sized 5 x 10 cm, resection anastomosis of the segment of ileum was performed. When opened it contained a surgical sponge with no external communication but an internal fistulous tract was present between the proximal and distal loops beyond the mass. Though intraluminal migration of retained surgical sponge has often been reported, complete intraluminal migration without features of obstruction or external opening is rarely seen.

Intracranial ricocheting of bullet from anterior clinoid process.

Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.

Bilateral pleural effusions following central venous cannulation.

We describe a patient who developed bilateral pleural effusions as a delayed complication following central venous catheter insertion. Respiratory distress should not only raise the clinical suspicion of a pneumothorax but also of erosion and perforation of the central vein. The mechanism, diagnosis, management and prevention of this complication are discussed.

An Impacted Clamshell in the Duodenum Mistaken for a Gall Stone

Although most ingested foreign bodies pass through the gastrointestinal tract spontaneously, those that are sharp, pointed, or large require removal to avoid serious complications. Here we report an interesting case of a 60-year-old man who swallowed a clamshell that passed through the pylorus and was caught in the duodenum. Radiologic findings made it look like a biliary stone. Endoscopic retrieval of the clamshell with a Dormia Basket was performed safely and the patient was discharged uneventfully on the day of the procedure.