A case report of successful removal of multiples sewing needles in the gastrointestinal tract and pancreas using intraoperative C-arm fluoroscopy.

BACKGROUND: Most ingested foreign bodies pass uneventfully through the digestive tract without any major disturbances.

OBJECTIVES: We reports a rare case of successful localization and surgical removal of needles in the gastrointestinal tract using C-arm fluoroscopy intraoperatively.

CASE REPORT: A 46year old female, a non-hospitalized psychiatric patient, presented with acute abdominal pain. Imaging showed 16 needles all over the digestive tract. C arm fluoroscopy was used to successfully localize and remove all of the needles intraoperatively. One needle was withdrawn from the pancreas manually without pancreatic resection.

DISCUSSION: It is estimated that up to 10-20% cases require endoscopic removal and 1% cases with the presence of obstruction or perforation necessitate surgical interventions [1-4] (Hsieh et al., 2005; Anderson and Dean, 2011; Cheng and Tam, 1999; Ricci et al., 2014). Migration to the pancreas extremely rare [5,6] (Toyonaga et al., 2001; Yasuda et al., 2010). Timely diagnosis can be difficult [7] (Tsui and Mossey, 1997). CT scan is a modality of choice to preoperatively locate the foreign body [8] (Takada et al., 2000). We herein successfully localized and removed 15 needles using C-arm fluoroscopy intraoperatively. It is extremely useful to accurately detect radiopaque foreign bodies. On the basic of findings on CT, treatment of choice such as endoscopic removal or surgical intervention may be attempted.

CONCLUSIONS: CT scan is a modality of choice to preoperatively locate the foreign body. Sharp-pointed objects should be removed even if the patient is asymptomatic as the increased mortality and the risk of related complications. Intraoperative C-arm fluoroscopy is a feasible, cost-effective modality with real-time image to accurately detect multiple radiopaque objects especially when they are disseminating throughout the digestive tract.