RSS-Feed abonnieren
DOI: 10.1055/s-0042-123704
Intra-arterial migration of a fractured endoscopic needle
Publikationsverlauf
Publikationsdatum:
30. Januar 2017 (online)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/lookinside/thumbnails/15007_10-1055-s-0042-123704-1.jpg)
A 53-year-old man with chronic pancreatitis presented with abdominal pain and sepsis. Imaging revealed a liver abscess secondary to distal biliary obstruction. Following drainage of his abscess, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with placement of a fully covered metal biliary stent across a 2-cm suspicious shouldered and irregular low common bile duct stricture. A pancreatic head malignancy was suspected at ERCP and on computed tomography (CT) imaging. The regional specialist hepatobiliary multidisciplinary team (MDT) recommended endoscopic ultrasound with fine needle aspiration (EUS-FNA).
EUS-FNA was difficult because of the changes of severe chronic calcific pancreatitis, duodenal stenosis, increased pancreatic head vascularity, and metal stent artefact. Five needle passes were made with a 22-gauge needle (Boston Scientific, Marlborough, Massachusetts, USA) using standard technique. Cytology was consistent with pancreatitis, with no evidence of malignancy.
A routine chest radiograph 6 months later revealed a new linear density in the heart ([Fig. 1]). The interim abdominal CT imaging was re-reviewed ([Fig. 2]). Although not recognized at the time, owing to the highly calcified pancreas, it became clear that a fractured EUS-needle tip had migrated from the duodenal wall into the epigastrium ([Fig. 3]), then through the diaphragm and into the left ventricle. On a subsequent chest radiograph, the needle had disappeared and a further CT scan revealed that it had migrated to the aortic bifurcation ([Fig. 4 a]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-123704-i15007cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-123704-i15007cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-123704-i15007cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-123704-i15007cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
The needle was retrieved endovascularly via bilateral common femoral artery access. It was first snared from above with a protective occlusion balloon placed below in the left iliac artery ([Fig. 4 b]). The balloon was deflated, the needle was snared from below and was then removed through the left groin sheath ([Fig. 4 c]; [Video 1]). The patient made an uneventful recovery after the procedure.
Video 1: Endovascular removal of an intra-arterial fractured needle. The needle was snared from above with a protective occlusion balloon below in the left iliac artery. The balloon was deflated, then the needle was snared from below and removed through the groin sheath.Qualität:
Endoscopic needle fracture has been previously described in the upper gastrointestinal tract [1] [2] and in a bronchoscopy setting [3]. Fractured metal sharps such as orthopedic fixation wires have been known to migrate into the arterial circulation, including into the heart [4]. This is the first known case of an endoscopic needle migrating intra-arterially.
Endoscopy_UCTN_Code_CPL_1AJ_2AZ
-
References
- 1 Rimbaș M, Attili F, Andrade Zurita S. et al. Fractured needle during endoscopic ultrasound-guided fine-needle aspiration of a pancreatic head mass. Endoscopy 2015; 47 (Suppl. 01) E432
- 2 DeWitt J, Sherman S, Lillemoe KD. Fracture of an EUS-guided FNA needle during an attempted rendezvous for an inaccessible pancreatic duct. Gastrointest Endosc 2011; 73: 171-173
- 3 Özgül MA, Çetinkaya E, Tutar N. et al. An unusual complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): the needle breakage. Ann Thorac Cardiovasc Surg 2014; 20 Suppl: 567-569
- 4 Leonardi F, Rivera F. Intravascular migration of a fractured cerclage wire into the left heart. Orthopedics 2014; 37: e932-e935