A man in Vietnam recently underwent a successful laparoscopic surgery to remove a six-centimeter sewing needle that had migrated into his liver, causing a significant abscess. The case highlights the rare but serious potential complications of foreign body ingestion.
The patient, identified as TTL, 39, from Vinh Long province, presented to the hospital on , with severe upper abdominal pain and a high fever. Diagnostic imaging, including abdominal sonography and computed tomography (CT) scans, revealed a 5 x 6 cm liver abscess containing a metallic foreign body approximately 6 cm in length.
Foreign body ingestion is a relatively common occurrence, but migration to the liver is exceedingly rare. According to a 2018 case report published in the International Journal of Surgery Case Reports, less than 1% of ingested foreign bodies require surgical intervention, and liver migration is an uncommon complication. The case report details the successful laparoscopic removal of a sewing needle from the liver of a 32-year-old female who presented with epigastric abdominal pain four months after suspected foreign body ingestion.
The surgical team at the hospital in Vinh Long opted for an emergency laparoscopic procedure to remove the needle and drain the abscess. Laparoscopy, a minimally invasive surgical technique, allows surgeons to access the abdominal cavity through small incisions, offering advantages such as reduced pain, faster recovery times, and smaller scars compared to traditional open surgery. The procedure, lasting nearly 60 minutes, successfully extracted the sewing needle and drained approximately 200 ml of cloudy pus from the abscess. This approach, as noted in a 2023 case report published in the Journal of Surgical Case Reports, is increasingly utilized for intrahepatic foreign bodies, offering a safe and effective removal method.
The patient demonstrated a remarkable recovery, being able to walk, eat a light diet, and resume basic daily activities within 24 hours of the surgery. Inflammatory markers and overall health showed significant improvement post-operatively. This rapid recovery underscores the benefits of laparoscopic intervention in appropriate cases.
The case is particularly noteworthy because it demonstrates the potential for successful laparoscopic management of hepatic foreign bodies. While some cases may require open surgery (laparotomy), the laparoscopic approach, as highlighted in research published in Surgical Innovations, can minimize invasiveness and promote faster healing. A case report from 2018, also published in the International Journal of Surgery Case Reports, details the experience of a team at the University of Ottawa Hospital in Canada, successfully removing a sewing needle from the liver laparoscopically.
Interestingly, not all cases of foreign bodies in the liver require surgical intervention. A case documented in ScienceDirect involved a patient who refused surgery and was followed for six years without intervention. However, the optimal management strategy remains debated, and the decision to operate depends on factors such as the size, shape, and location of the foreign body, the presence of complications like infection or pain, and the patient’s overall health and preferences.
The successful outcome in the Vietnamese patient emphasizes the importance of prompt evaluation and management of patients presenting with suspected foreign body ingestion, particularly when accompanied by abdominal pain or signs of infection. While most foreign bodies pass through the gastrointestinal tract without incident, the potential for serious complications, such as liver migration and abscess formation, necessitates a high index of suspicion and appropriate diagnostic workup. The case also highlights the growing role of laparoscopic surgery in the management of complex abdominal conditions, offering patients a less invasive and potentially faster path to recovery.
The use of laparoscopic techniques for removing foreign bodies, even those that have penetrated abdominal viscera, is becoming increasingly common, as demonstrated in a 2022 case report published in PubMed. This report details the laparoscopic removal of two sewing needles from a 26-year-old female who intentionally ingested them, with one needle having penetrated the stomach and migrated to the peritoneal cavity. The choice of laparoscopic removal was based on the traumatic nature of the needle and its location outside the gastrointestinal tract.
