Unstable Lumbar Spine Osteomyelitis Caused by Trans-Foraminal Migration of Laparoscopic Adjustable Gastric Band Connection Tubing: A Case Report.

Background: Disconnection of the tubing between the port and LAGB is a well-known complication in general surgery and accounts for up to 17% of LAGB complications. Typically, when this complication occurs patients present with abdominal or pelvic complaints. A complication of spinal infection due to trans-foraminal migration has not been previously reported. The aim of this study is to highlight an unusual infection of the thoracolumbar spine due to laparoscopic adjustable gastric band (LAGB) intragastric erosion, and migration into the lumbar spine causing epidural abscesses, discitis, and osteomyelitis. This case underscores the importance of a thorough surgical history, complete imaging, and multi-disciplinary approach in management of complex spine infections. Methods: We report a case of LAGB tubing migration into the spinal canal through the left L2/L3 neural foramen resulting in symptomatic epidural abscesses and osteomyelitis. Results: Although dislodgement and migration of LAGB tubing has been reported previously, this is the first report of trans-foraminal migration and erosion of lumbar vertebrae, causing osteomyelitis of the spine and epidural abscess formation, subsequent instability and neurologic deficit requiring urgent operative intervention. Conclusions: Dislodgement and migration of LAGB tubing is a known complication. While it most commonly leads to abdominal and pelvic sequelae, in rare circumstances it may acutely affect the spine. Careful history, imaging, and multidisciplinary approach are paramount for the successful management.Level of Evidence: V.

Inguinal Extrusion of a Ventriculoperitoneal Shunt.

BACKGROUND: Complications of ventriculoperitoneal (VP) shunts include migration into various anatomic compartments and even extrusion through tissue layers. CASE DESCRIPTION: A 31-year-old female patient with a VP shunt presented with distal shunt tubing extruding through the skin at the level of the inguinal ligament. Shunt hardware was removed, and cultures grew Dermacoccus. The patient was treated with broad-spectrum antibiotics and underwent placement of a lumboperitoneal shunt. CONCLUSIONS: Dermacoccus is a gram-positive skin organism with rare human pathogenicity and not previously known to cause shunt infections.

Sepsis Caused by Bacterial Colonization of Migrated Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery: A First Case Report and Literature Review.

BACKGROUND: Migration of distal ventriculoperitoneal (VP) shunt catheter into another body part has been described as a potentially serious surgical complication. We present the first case of sepsis caused by transcardial and pulmonary migration of a distal catheter into the heart and pulmonary artery, which was subsequently colonized by Klebsiella pneumoniae. CASE REPORT: A 56-year-old man underwent VP shunt insertion for hydrocephalus that developed after the surgery for intracranial meningioma. Three years later, he was admitted to department for infectious diseases because of persistent fever. Klebsiella pneumoniae was isolated from the blood cultures. Computed tomography (CT) of the thorax showed migration of the distal catheter into the heart and pulmonary artery. The migrated shunt catheter was retrieved without any complication with the assistance of a cardiovascular surgeon; microbiologic analysis confirmed that the catheter was colonized with K. pneumoniae. We decided to delay new VP shunt placement because of the positive blood cultures, and 3 weeks after the surgery, the patient was without signs of increased intracranial pressure and without any heart problems. CONCLUSION: Migration of a distal VP shunt catheter into the heart should be considered in patients with a previously placed VP shunt presenting with cardiopulmonary problems, arrhythmia, and/or fever. Neurosurgeons should be involved as soon as possible, and a multidisciplinary approach is warranted.

Smooth Pins Reinforcing Static Cement Spacers for Infected Total Knee Arthroplasty Are Not Safe.

Prosthetic joint infection is one of the most dreaded complications following elective lower extremity primary total joint arthroplasty, resulting in substantial pain, disability, and health care costs. Both static and articulating antibiotic-impregnated spacers have been used in the management of 2-stage revision for infected total knee arthroplasty, which remains the gold standard for treatment of these infections. Articulating spacers may provide theoretical benefits with regard to improved range of motion after reimplantation secondary to less scar formations and soft tissue contractures. However, static spacers may be necessary to overcome instability associated with substantial bone defects, incompetent extensor mechanisms, and collateral ligament insufficiencies. In these scenarios, static spacers are often reinforced with intramedullary rods or Steinmann pins to provide additional knee stability, improve construct strength, maintain extension, and avoid flexion contractures. This case report describes an extremely rare case of migration of smooth pins through the posterior tibia into the calf following static spacer use in a 48-year-old man. Various mechanical and systemic complications have been reported in up to 50% of patients with the use of polymethyl methacrylate spacer devices, such as acute renal failure, allergic reactions from antibiotic use, stiffness, bone loss, fractures, and dislocations. However, to the best of the authors' knowledge, this complication of hardware migration has not been reported previously in the literature. The authors believe that orthopedic surgeons should consider the use of threaded pin dowels or intramedullary rods to avoid this potential untoward complication. [Orthopedics. 2016; 39(3):e553-e557.].

From interventional radiology to laparoscopic liver resection as complementary strategies in the treatment of hepatic abscess caused by ingested foreign bodies.

Hepatic abscess from orally ingested foreign bodies are uncommon. We report here two cases of such a condition treated by foreign body extraction by interventional radiology in one patient and by laparoscopic left lateral sectionectomy after failure of a percutaneous radiological approach in the second. Postoperative course was uneventful and after a clinical follow-up of 11 and 12 months, respectively, both patients were free of symptoms.

Staple metalloptysis after lung resection for mycetoma: a case report and a review of the literature.

The expectoration of metal fragments (metalloptysis) is a rare complication after thoracic surgery. It usually occurs in patients with severe emphysema. We present a case of metalloptysis of surgical staples that is unique in several aspects: it occurred longer after surgery than any previously reported case, it occurred after lobar resection surgery, and it most likely developed as a result of chronic necrotizing aspergillosis. Although metalloptysis usually requires no therapy, it may indicate an active infectious process that requires appropriate therapy.

Transobturator tape erosion associated with leg pain.

A 39 year-old vaginal multipara status postpubovaginal sling in 2002 and a transobturator tape procedure in 2004 presented with persistent stress incontinence and vaginal polypropylene mesh erosion. Ten days later, she presented to the emergency room with severe right groin pain, difficulty walking, fever, and chills. She described shooting pain originating from the right inguinal ligament radiating down her right leg anteriorly. Although her neurologic examination was normal, palpation of the right obturator internus muscle reproduced her pain. MRI clearly revealed the course of the mesh tape through the obturator muscles and marked increase in the size of the right adductor and obturator internus muscles, apparently compressing the adjacent neurovascular fascicle. The patient was taken to the operating room where the polypropylene tape was easily removed through the vaginal erosion. Mesh cultures were positive for bacteroides fragilis. She experienced complete symptom resolution within 1 week of tape removal.

Fungal keratitis caused by Paecilomyces lilacinus associated with a retained intracorneal hair.

OBJECTIVE: To report a case of fungal keratitis caused by Paecilomyces lilacinus (P. lilacinus) associated with a retained intracorneal hair. METHODS: A 61-year-old man developed pain, decreased vision, hyperemia, and corneal infiltrates in his right eye without any predisposing factor. An intracorneal hair had migrated superiorly in the corneal stroma, giving rise to 3 separate stromal infiltrates. The patient demonstrated a waxing and waning course over several months despite antimicrobial and steroid therapy. RESULTS: Histopathologic examination of a corneal biopsy specimen disclosed the presence of fungal elements, and intensive antifungal therapy was initiated. Verticillium sp. was initially identified as the causative organism, but after failure to improve on topical natamycin, subsequent investigations demonstrated the pathogen to be P. lilacinus that was resistant to routine antifungal agents. The patient was then initiated on systemic voriconazole and terbinafine. He responded well to treatment and ultimately recovered a best-corrected visual acuity of 6/15 in the affected eye. CONCLUSION: This is the first case of P. lilacinus keratitis associated with a retained intracorneal hair. Hair in the cornea could be a predisposing factor for this infection. Early corneal biopsy should be considered to properly diagnose and manage atypical keratitis and to prevent further complications.

Extrusion of an anterior chamber intraocular lens complicated by Haemophilus endophthalmitis.

PURPOSE: To describe a case of late postoperative endophthalmitis in a patient who had undergone anterior chamber intraocular lens implantation 6 years previously. METHOD: Onset, course, and outcome of the patient's eye disease are presented. RESULTS: The patient was initially examined with erosion of the eyewall, extrusion of the lens haptic, and endophthalmitis. Intraocular cultures disclosed the pathogenic organism to be Haemophilus influenzae. CONCLUSION: Anterior chamber intraocular lens haptic extrusion can have grave consequences, including endophthalmitis and severe visual loss.

Grass awn migration in dogs and cats: a retrospective study of 182 cases.

A retrospective study of 182 cases of grass awn migration in dogs and cats seen during a 1-year period was performed. The 182 cases comprised 61% of all foreign body-related cases during that year. Compared with the total hospital population, there was an increased prevalence of grass awn problems in the Springer Spaniel, Golden Retriever, Brittany Spaniel, and Airedale Terrier, but a decreased prevalence in German Shepherd Dogs, Miniature Poodles, and Dachshunds. The most common site of grass awn localization was the external ear canal, involving 51% of grass awn cases. Other common sites of grass awn localization included the interdigital webs, eye, nose, lumbar area, and thoracic cavity. Only 8 of the 182 animals were cats and 7 of the 8 had ocular involvement.