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      Ileocecal junction perforation caused by a sewing needle in incarcerated inguinal hernia : An unusual case report

      case-report

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          Abstract

          Introduction:

          This case study is concerning the meticulous observation of the moving process and track of 2 ingested needles using interval x-ray radiography, trying to localize the foreign bodies and reduce unnecessary exploration of digestive tract.

          Case presentation:

          An unusual case of a 1-year, 9-month-old female baby, with incarcerated hernia perforation caused by sewing needles with sharp ends, was reported herein. The patient had swallowed 2 sewing needles. One needle was excreted uneventfully after 8 days. On the contrary, the other needle stabbed the ileocecal junction wall into the right side of inguinal hernia sac after 9 days, and the patient received successful operation management. Interval x-ray confirmed that 1 needle-like foreign body moving down in 8 days until excretion along with feces. However, the other pierced into the incarcerated hernia. Preoperative x-ray radiography successfully monitored the moving process and tract of the sewing needles. Considering the penetrating-migrating nature of the foreign bodies, once the sharp-pointed objects were located, they should be removed as the mortality and risk of related complications may be increased.

          Conclusion:

          Interval x-ray radiography represents a meticulous preoperative monitoring method of the moving process and tract of needle-like foreign bodies. Interval x-ray with real-time images accurately detecting the moving foreign bodies could be help to reduce the unnecessary exploration of digestive tract and subsequently prevent possible complications. Based on the basic findings from the interval x-ray, treatment choices of endoscopic removal and surgical intervention may be attempted.

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          Most cited references20

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          Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee.

          Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.
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            Management of ingested foreign objects and food bolus impactions.

            G Ginsberg (1994)
            This review article is intended to aid the clinician in the evaluation and management of older children and adult patients with possible foreign object ingestion and/or food bolus impaction. A literature search was performed in June 1993 on the Medline using Medlars II, the National Library of Medicine's National Interactive Retrieval Service. This search generated 181 citations. References chosen for review were English-language citations from the gastroenterology, otolaryngology, general surgical, and radiological literature. As little or no data exist from well-designed prospective trials, emphasis was given to results from large series. In preparing this manuscript several drafts were distributed to the members of the American Society for Gastrointestinal Endoscopy, Standards of Practice Committee, and to national experts on the subject for critical review.
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              Foreign bodies in the gastrointestinal tract and anorectal emergencies.

              Of all ingested foreign bodies (FBs) brought to the attention of physicians (probably a small minority of the total), 80% to 90% pass spontaneously; however, 10% to 20% require endoscopic removal, and about 1% require surgery. The article divides the GI tract into regions in which the anatomy, presentation, clinical findings, and management of FBs are distinct. The final third of this article describes the management of anorectal emergencies. An understanding of anatomy and common pathological conditions allows the emergency physician to make a diagnosis and provide relief and/or resolution in most cases.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                June 2018
                01 June 2018
                : 97
                : 22
                : e10787
                Affiliations
                [a ]Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
                [b ]Xinjiang Institute of Pediatrics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, P.R. China
                [c ]The Interdisciplinary Centre for Security, Reliability and Trust (Sn T), University of Luxembourg, Luxembourg, Luxembourg
                [d ]Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shanxi Province
                [e ]Third Department of General Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang
                [f ]Department of Basic Surgery, Beijing Children's Hospital, Capital Medical University, Beijing
                [g ]Department of Neonatal Intensive Care Unit, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province, P.R. China.
                Author notes
                []Correspondence: Yi Lv, Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, No. 277, West Road, Yanta District, Xi’an, Shaanxi Province 710061, P.R. China (e-mail: liushiqi23@ 123456foxmail.com ).
                Article
                MD-D-17-06610 10787
                10.1097/MD.0000000000010787
                6393046
                29851786
                9889be08-65d1-4497-ba01-76c21915333e
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 20 December 2017
                : 17 April 2018
                Categories
                6200
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                foreign body,incarcerated hernia,needle migration,x-ray radiography

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