Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.
Bone Wires ; adverse effects ; Foreign-Body Migration ; complications ; Humans ; Humeral Fractures ; surgery ; Hydropneumothorax ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND/AIMS: To determine the prevalence and time-course of t-fastener migration after gastropexy deployment. METHODS: We reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion. RESULTS: A total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified. CONCLUSIONS: Following gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.
Abdominal Wall/surgery ; Enteral Nutrition ; Female ; Foreign-Body Migration/complications/*epidemiology ; Gastropexy/adverse effects/*instrumentation ; Humans ; *Intubation, Gastrointestinal ; Male ; Middle Aged ; Retrospective Studies ; *Surgical Fixation Devices/adverse effects ; Time Factors

Female ; Foreign-Body Migration ; complications ; diagnosis ; surgery ; Humans ; Lung ; Middle Aged ; Rib Fractures ; complications

Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant biliary strictures given the long duration of stent patency owing to their larger stent diameter. Recently, SEMS has been used in a variety of benign biliary strictures and leaks, especially with the design of the covered self-expandable metal stent (CSEMS), which permits endoscopic-mediated stent removal. The use of CSEMS in benign biliary stricture could potentially result in a decrease in endoscopic sessions and it is technically easier when compared to placement of multiple plastic stents. However, complications such as cholecystitis due to blockage of cystic duct, stent migration, infection and pancreatitis have been reported. The potential subsegmental occlusion of contralateral intrahepatic ducts also limits the use of CSEMS in hilar stricture. Certain techniques and improvement of stent design may overcome these challenges in the future. Thus, CSEMS may be appropriate in only highly selected conditions, such as refractory benign biliary stricture, despite multiple plastic stent placement or difficult to treat bile duct stricture from chronic pancreatitis, and should not be used routinely. This review focuses on the use of fully covered self-expandable metal stent for benign biliary strictures and bile leaks.
*Bile ; Biliary Tract Diseases/diagnosis/etiology/*surgery ; Coated Materials, Biocompatible ; Constriction, Pathologic ; Diagnostic Imaging ; Equipment Design ; Foreign-Body Migration ; Humans ; Metals ; Plastics ; Postoperative Complications ; Sphincterotomy, Endoscopic ; *Stents

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.
Biliary Tract Diseases/*surgery ; Coated Materials, Biocompatible ; Device Removal ; Drainage/methods ; Endoscopy ; Foreign-Body Migration/surgery ; Humans ; Metals ; Postoperative Complications/surgery ; *Stents/adverse effects

OBJECTIVE: To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures. MATERIALS AND METHODS: Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft. RESULTS: In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days). CONCLUSION: Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant.
Adult ; Anastomosis, Surgical/adverse effects ; Cholestasis/etiology/*surgery ; Constriction, Pathologic ; Device Removal ; Female ; Foreign-Body Migration ; Humans ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; *Postoperative Complications ; *Stents ; Young Adult

Adult ; Device Removal ; Equipment Failure ; Female ; Foreign-Body Migration ; surgery ; Heart Septal Defects, Atrial ; surgery ; Humans ; Myocardial Revascularization ; adverse effects ; instrumentation ; Postoperative Complications ; etiology

Aged ; Aged, 80 and over ; Foreign-Body Migration ; etiology ; Hernia, Inguinal ; surgery ; Humans ; Intestinal Obstruction ; etiology ; Male ; Postoperative Complications ; etiology ; Surgical Mesh

The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy/*adverse effects ; Foreign Bodies/*complications ; Foreign-Body Migration/*complications ; Gallstones/*etiology/surgery ; Humans ; Male ; Risk Factors ; Surgical Instruments ; Sutures/*adverse effects

BACKGROUND: Foreign objects in the gastrointestinal tract are usually the result of accidental swallowing. Yet foreign object ingestion is often seen in prisoners who mainly desire to leave prison. We report here on a series of 33 Korean prisoners with foreign object ingestion and they were treated endoscopically or surgically. METHDOS: We reviewed the medical records of 33 Korean prisoners (52 episodes) who were admitted due to ingestion of foreign objects between January 1998 and June 2004 to Konyang University Hospital and Gyeongsang National University Hospital. RESULTS: All the patients were male with a mean age of 35 years. The most common duration from ingestion to the visit to the ER was within 24 hours (25/52 episodes). Most of the foreign objects were located in the esophagus (42.3%) and stomach (42.3%). The number of foreign objects was one in 28 episodes, two in 12 episodes and three or more in twelve episodes. The most common foreign objects were metal wires (26/52 episodes). The mean size of the foreign objects was 11.9 centimeters long. Successful endoscopic treatment was performed in most patients (46/52 episodes, 88.5%). The remaining six cases were treated surgically. CONCLUSIONS: The foreign objects in prisoners were a variety of unusual things because of the prison environment, and endoscopy is a mainstay of treatment for foreign object removal in Korean prisoners.
Accidents ; Adult ; *Deglutition ; *Endoscopy, Gastrointestinal ; Foreign Bodies/*surgery ; Foreign-Body Migration/complications/*surgery ; Gastrointestinal Tract/*injuries ; Humans ; Korea ; Male ; *Prisoners ; *Prisons ; Risk Factors