title: Combined laparoscopic and endoscopic approach for the management of two ingested sewing needles: one migrated into the liver and one stuck in the duodenum.
abstract: In this paper, we present the case of a 35-year-old Caucasian female, instituted for depression, who swallowed two sewing needles. Despite the fact that the patient on presentation was asymptomatic with a normal clinical examination and blood tests, the workup revealed a contained perforation of the upper gastrointestinal tract (GI) and a migration of one needle to the liver. Moreover, the endoscopy alone failed to remove the other needle, which was stuck in the duodenal wall and, therefore, a combined endoscopic and laparoscopic approach was successfully applied to remove both needles through the abdominal wall. The postoperative recovery was immediate and the patient was discharged after 24 hours. Our aim in this study was, to introduce a combined laparoscopic and endoscopic approach for the removal of any sharp object that gets stuck in the stomach or duodenal wall. Such a technique can be used in difficult cases where endoscopy alone fails to remove sharp objects that get stuck in the alimentary track and where the risk of complications is high. Moreover, we want to discuss the safety and efficacy of the laparoscopic approach in the management of the rare cases of migrated sharp objects from the upper GI tract to the abdominal cavity, provided there is a good preoperative localization. This combined technique has shown excellent results; it is safe and easy to perform and a laparotomy can be avoided. Moreover, the laparoscopic approach is a safe, efficient approach to remove those sharp objects that have migrated into the peritoneal cavity.
authors.affiliation: General Surgery Unit, St. Mary's Hospital, London, United Kingdom. drlanitis@yahoo.com
authors.forename: Sophocles
authors.initials: S
authors.lastname: Lanitis
authors.forename: George
authors.initials: G
authors.lastname: Filippakis
authors.forename: Thalis
authors.initials: T
authors.lastname: Christophides
authors.forename: Timotheos
authors.initials: T
authors.lastname: Papaconstandinou
authors.forename: Constantine
authors.initials: C
authors.lastname: Karaliotas
mesh_terms: D000328:Adult; D003679:Deglutition; D004386:Duodenum / Q000293:injuries; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005547:Foreign Bodies / Q000209:etiology / Q000601:surgery*; D005548:Foreign-Body Migration / Q000601:surgery; D006801:Humans; D007413:Intestinal Mucosa / Q000293:injuries; D007416:Intestinal Perforation / Q000209:etiology; D010535:Laparoscopy; D008099:Liver / Q000293:injuries; D009339:Needles / Q000009:adverse effects; D012449:Safety; D016896:Treatment Outcome