Laparoscopic Removal of a Swallowed Sewing Needle That Migrated into the Greater Omentum Without Clinical Evidence

Abstract

We report a case of a sewing needle, presumably originating from the transverse colon or the ligament of Treitz, that migrated to the greater omentum. A 24-year-old woman was referred to our clinic with a complaint of abdominal pain which was exacerbated by breathing or any physical activity. Abdominal plain x-ray showed a needle in the left upper abdominal area. Abdominal computed tomography (CT) and contrast enhanced x-ray studies was unable to reveal whether the needle was in the colonic lumen. Virtual colonoscopy examination demonstrated that the foreign body was not in the lumen. The foreign body was removed from the patient's greater omentum in a fluoroscopy- guided laparoscopic surgery. An accurate and rapid diagnosis of a perforation in the gastrointestinal tract as the result of an ingested foreign body is difficult in the absence of peritonitis or abscess formation. In such cases, the virtual colonoscopy is useful if there is uncertainty whether the foreign body is in the lumen. Perioperative fluoroscopy can be useful to overcome the lack of tactile discrimination in laparoscopy, in patients who have been scheduled for surgery who have no signs of the localization of the foreign body (such as abscess or solid organ migration).