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1.
Obes Surg ; 34(6): 2237-2247, 2024 Jun.
Article En | MEDLINE | ID: mdl-38703242

Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. The incidence and consequences of sleeve migration (SM) are not clearly understood. There is no clear consensus on appropriate measures to reduce the risk of SM. This study systematically reviewed the literature and identified 405 cases of SM from 21 studies. Age ranged from 18 to 68 years. Thirty-two percent and 11% of patients were females and males respectively, while sex was not reported in 57%. Time to diagnosis ranged from 1 day to 5 years postoperatively. A total of 9.6% and 58.8% of patients had or had no previous hiatal hernia respectively. SM incidence, risk factors, proposed mechanisms, clinical presentation, diagnosis, management, and potential preventive strategies are described in this review.


Gastrectomy , Obesity, Morbid , Humans , Gastrectomy/adverse effects , Obesity, Morbid/surgery , Female , Male , Adult , Risk Factors , Middle Aged , Incidence , Foreign-Body Migration/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Bariatric Surgery/adverse effects , Aged , Hernia, Hiatal/surgery , Adolescent
3.
J Med Case Rep ; 18(1): 234, 2024 May 02.
Article En | MEDLINE | ID: mdl-38698425

BACKGROUND: Nexplanon implants are a common hormonal contraceptive modality. Though rare, these devices can embolize into the injured wall of the basilic vein, through the right heart, and finally wedge itself into a pulmonary artery. With adherence to the arterial wall over time, it becomes less amenable to endovascular retrieval. Patients may present with symptoms mimicking a pulmonary embolism, or without any symptoms at all. In asymptomatic cases, endovascular retrieval and/or surgery is required when patients wish to begin having children prior to biological inactivity. The current literature showed as little as nine case reports detailing lung tissue removal in the aim of reversing a patient's implanted contraceptive device. CASE PRESENTATION: A 22-year-old asymptomatic active-duty Caucasian female presented for elective outpatient Nexplanon removal. The suspicion of possible implant migration arose when it was discovered to be non-palpable in her left arm. After plain film x-rays failed to localize the implant, a chest x-ray and follow-up Computed Tomography (CT) scan revealed that the Nexplanon had migrated to a distal branch of the left pulmonary artery. Due to the patient's strong desires to begin having children, the decision was made for removal. Initial endovascular retrieval failed due to Nexplanon encapsulation within the arterial wall. Ultimately, the patient underwent a left video-assisted thoracoscopic surgery (VATS) for exploration and left lower lobe basilar S7-9 segmentectomy, which successfully removed the Nexplanon. CONCLUSIONS: Implanted contraceptive devices can rarely result in migration to the pulmonary vasculature. These radiopaque devices are detectable on imaging studies if patients and clinicians are unable to palpate them. An endovascular approach should be considered first to spare lung tissue and avoid chest-wall incisions, but can be complicated by encapsulation and adherence to adjacent tissue. A VATS procedure with single-lung ventilation via a double-lumen endotracheal tube allows surgeons to safely operate on an immobilized lung while anesthesiologists facilitate single-lung ventilation. This patient's case details the uncommon phenomenon of Nexplanon migration, and the exceedingly rare treatment resolution of lung resection to remove an embolized device.


Desogestrel , Device Removal , Foreign-Body Migration , Humans , Female , Device Removal/methods , Desogestrel/administration & dosage , Foreign-Body Migration/surgery , Foreign-Body Migration/diagnostic imaging , Young Adult , Contraceptive Agents, Female/administration & dosage , Drug Implants , Pulmonary Artery/surgery , Pulmonary Artery/diagnostic imaging , Tomography, X-Ray Computed , Pulmonary Embolism/etiology , Treatment Outcome , Pneumonectomy
4.
Eur J Contracept Reprod Health Care ; 29(3): 115-130, 2024 Jun.
Article En | MEDLINE | ID: mdl-38712717

INTRODUCTION: Migration is a rare but serious complication of the etonogestrel contraceptive implant, and little is known about its extent. PURPOSE: To document and characterise cases of etonogestrel contraceptive implant migration in the scientific literature. METHODS: A systematic review of Medline, Embase and Global Health databases was carried out between January 2000 and January 2023 to identify articles presenting implant migrations. Narrative reviews, conference abstracts and articles not written in English or French were excluded. RESULTS: Forty-five articles, mostly published since 2016, were identified (eight case series and 37 case reports), for a total of 148 independent cases of migration: in pulmonary blood vessels (n = 74), in non-pulmonary blood vessels (n = 16) and extravascular (n = 58). Many patients are asymptomatic and migration is often an incidental finding. A non-palpable implant and symptoms related to implant location (intra- or extra-vascular) may be indicative of migration. Inadequate insertion and normal or underweight appear to increase the risk of migration. Scientific societies and authors offer practical strategies to deal with implant migration. CONCLUSION: Professionals who insert and remove contraceptive implants must be adequately trained. They need to be on the lookout for implant migration, and promptly refer patients to appropriate care if migration is suspected.


This systematic review documents and characterises 148 cases of vascular and extravascular etonogestrel contraceptive implant migration. Healthcare professionals must be aware of this rare but serious complication and be adequately trained to insert and remove contraceptive implants.


Contraceptive Agents, Female , Desogestrel , Drug Implants , Foreign-Body Migration , Humans , Desogestrel/administration & dosage , Desogestrel/adverse effects , Female , Drug Implants/adverse effects , Contraceptive Agents, Female/administration & dosage , Contraceptive Agents, Female/adverse effects , Device Removal , Contraceptive Agents, Hormonal/adverse effects , Contraceptive Agents, Hormonal/administration & dosage
6.
Jt Dis Relat Surg ; 35(2): 439-442, 2024 Apr 26.
Article En | MEDLINE | ID: mdl-38727126

Tension band wiring (TBW) is one of the most commonly used fixation techniques to fix olecranon osteotomies. Hardware prominence has been the most commonly reported complication of TBW. However, distal migration of Kirschner (K)-wire after TBW fixation for olecranon osteotomy has not been reported. In this case report, we presented distal migration of K-wire detected nine months after initial surgery in a 46-year-old male patient. The patient was operated on for an intraarticular distal humerus fracture using an olecranon osteotomy. The osteotomy was fixed with TBW fixation. The patient missed routine follow-ups and presented to the outpatient clinic with a complaint of skin irritation at the elbow nine months after the surgery. On radiological examination, distal migration of one K-wire was detected. The K-wire was surgically removed without any complication. Physicians should be aware of possible complications of TBW and remove fixation after fracture union to avoid unexpected complications.


Bone Wires , Foreign-Body Migration , Olecranon Process , Osteotomy , Humans , Bone Wires/adverse effects , Male , Middle Aged , Olecranon Process/injuries , Olecranon Process/surgery , Olecranon Process/diagnostic imaging , Osteotomy/adverse effects , Osteotomy/methods , Osteotomy/instrumentation , Foreign-Body Migration/surgery , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Humeral Fractures/surgery , Humeral Fractures/diagnostic imaging , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/instrumentation , Device Removal/methods , Elbow Joint/surgery , Elbow Joint/diagnostic imaging , Intra-Articular Fractures/surgery , Intra-Articular Fractures/diagnostic imaging
8.
Article En | MEDLINE | ID: mdl-38631862

Intrathoracic needles are rarely used in clinical practice. They can migrate within the body, injure large blood vessels and other organs, and cause severe complications. We report an interesting case of intrathoracic needle removal using video-assisted thoracoscopic surgery. The needle was inserted under the left clavicle, penetrated the mediastinum, and migrated into the right thoracic cavity. Although pneumothorax developed during the disease course, no severe complications were observed. This rare case illustrates the course of needle migration from the mediastinum into the thoracic cavity. Prompt imaging and surgical removal of foreign bodies are necessary in cases of intrathoracic foreign bodies.


Foreign Bodies , Foreign-Body Migration , Thoracic Cavity , Humans , Mediastinum , Treatment Outcome , Thoracic Cavity/surgery , Foreign Bodies/surgery , Thoracic Surgery, Video-Assisted/methods , Foreign-Body Migration/surgery
9.
J Investig Med High Impact Case Rep ; 12: 23247096241238527, 2024.
Article En | MEDLINE | ID: mdl-38646799

Biliary endoprostheses are widely used in the treatment of biliary lithiasis, malignant and benign strictures, and occasionally in long-lasting biliary fistulas. They can be placed endoscopically during endoscopic retrograde cholangiopancreatography and radiologically (percutaneous) when the endoscopic route is not feasible. Complications associated with the endoscopic placement of biliary endoprostheses are well described in the literature, with migration being the most common. Intestinal obstruction is a rare complication associated with the migration of these devices. There are no reports in the literature of this complication occurring after percutaneous placement. We present a case of a patient who arrived at the emergency department with ileal obstruction secondary to the migration and concurrent embedding of a covered stent placed radiologically to treat a biliary leak after surgery. The patient underwent diagnostic laparoscopic and ileal resection, revealing a lithiasic concretion at the tip of the stent, causing the small bowel obstruction.


Foreign-Body Migration , Intestinal Obstruction , Stents , Humans , Stents/adverse effects , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Foreign-Body Migration/surgery , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/complications , Male , Cholangiopancreatography, Endoscopic Retrograde , Female , Aged , Laparoscopy , Intestine, Small
10.
Abdom Radiol (NY) ; 49(5): 1646-1652, 2024 May.
Article En | MEDLINE | ID: mdl-38592493

PURPOSE: To evaluate the efficacy and safety of a novel technique for removal of migrated esophageal stent (MES) under fluoroscopy. METHODS: From January 2009 to April 2023, 793 patients with a dysphagia score of 3-4 underwent esophageal stenting at our center, and 25 patients (mean age: 70.06 years old; male/female: 15/10) underwent stent removal using "loop method" under fluoroscopy. The primary outcomes were technical success and complications. The secondary outcomes were procedure time, radiation exposure, biochemical indicators [white blood cell (WBC), hemoglobin (Hb), platelet (PLT), albumin (ALB), alanine transaminase (ALT), total bilirubin (TB), urea nitrogen (UN) and C-reactive protein] of pre- and post-treatment at 2 weeks. RESULTS: Technical success was 100% without major complications. The mean procedure time was (39.44 ± 9.28) minutes, which showed no statistical significance between benign (n = 5) and malignant (n = 20) group [(42.40 ± 8.85) vs (38.71 ± 9.46) mins, p > 0.05]. The mean radiation exposure was (332.88 ± 261.47) mGy, which showed no statistical significance between benign and malignant group [(360.74 ± 231.43) vs (325.92 ± 273.54) mGy, p > 0.05]. Pre- and post-procedure Hb [(114.46 ± 11.96) vs. (117.57 ± 13.12) g/L] and ALB [(42.26 ± 3.39) vs. (44.12 ± 3.77) g/L] showed significant difference (p < 0.05), while WBC, PLT, CRP, and ALT showed no significance (p > 0.05). CONCLUSION: Fluoroscopy-guided "Loop method" for MES removal is an effective and safe alternative technique.


Device Removal , Stents , Humans , Female , Fluoroscopy , Male , Aged , Device Removal/methods , Foreign-Body Migration/diagnostic imaging , Retrospective Studies , Middle Aged , Deglutition Disorders/etiology , Radiography, Interventional/methods , Aged, 80 and over
11.
World J Urol ; 42(1): 273, 2024 Apr 30.
Article En | MEDLINE | ID: mdl-38689135

PURPOSE: The purpose of this study is to evaluate the incidence, risk factors, and salvage management of retrievable covered expandable metallic stent (RCEMS) migration in patients with persistent benign ureter strictures. MATERIALS AND METHODS: A retrospective study was performed on 117 consecutive patients who underwent implantation of RCEMS. Univariate and multivariate analyses were used to identify prognostic factors for stent migration, including stricture location and length, hydronephrosis-cortex ratio, ureteral dilation, and the diameter of the narrowest portion of the stricture. RESULTS: Stent migration occurred in 22 (19.5%) of 113 patients who met inclusion criteria. Of the 22 patients, 16 (72.7%) had ordinary ureteral stricture, 3 (13.6%) had stricture in transplanted kidneys, and 3 patients (13.6%) had ureter stricture in orthotopic neobladders. The mean creatinine for the entire cohorts showed significant improvement (p = 0.038). Multivariate analysis identified the following prognostic factors for migration: distal ureteral stricture (p = 0.006), patients who underwent balloon dilation (p = 0.003), hydronephrosis-cortex ratio ≧10 (p = 0.017), larger diameter of wasting of RCEMS (p < 0.001), and patients with a shorter stricture length (p = 0.006). Salvage management was required in 4 of the 22 patients. The strictures in the remaining 18 patients improved with observation. CONCLUSIONS: Stent migration is more likely to occur in patients with the five prognostic factors mentioned above. Our study developed a nomogram to predict stent migration in patients with ureteral strictures treated using RCEMS.


Foreign-Body Migration , Ureteral Obstruction , Humans , Male , Retrospective Studies , Ureteral Obstruction/etiology , Ureteral Obstruction/therapy , Ureteral Obstruction/surgery , Female , Middle Aged , Foreign-Body Migration/epidemiology , Risk Factors , Adult , Aged , Device Removal , Self Expandable Metallic Stents , Prosthesis Failure , Constriction, Pathologic , Stents/adverse effects , Prosthesis Design , Young Adult
13.
Rev. argent. coloproctología ; 35(1): 40-44, mar. 2024. ilus
Article Es | LILACS | ID: biblio-1551683

En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)


In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)


Humans , Male , Female , Adult , Middle Aged , Anus Diseases/surgery , Anus Diseases/etiology , Biopolymers/adverse effects , Buttocks/surgery , Anus Diseases/diagnosis , Cosmetic Techniques , Foreign-Body Migration , Prosthesis Implantation/adverse effects
14.
J Med Case Rep ; 18(1): 184, 2024 Mar 28.
Article En | MEDLINE | ID: mdl-38539178

BACKGROUND: Fractures of the clavicle are common injuries, which often require reduction and internal fixation. Although Kirschner pins have been commonly used to treat these fractures with good results, migration of these devices may result in severe internal lesions. CASE PRESENTATION: We report herein the case of 61-year-old man, who presented for intrapulmonary migration of a Kirschner pin, 25 years after closed reduction and fixation of a clavicle fracture. CONCLUSION: Migration of an osteosynthesis pin can be lethal. Patients with osteosynthesis pins, should have a regular follow, until the removal of the wires.


Foreign-Body Migration , Fractures, Bone , Male , Humans , Middle Aged , Clavicle/diagnostic imaging , Clavicle/surgery , Clavicle/injuries , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Fracture Fixation, Internal , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Bone Wires/adverse effects
15.
J Vasc Interv Radiol ; 35(6): 890-894, 2024 Jun.
Article En | MEDLINE | ID: mdl-38447770

This report describes the experience of removing migrated gastrointestinal (GI) stents using a gastrostomy (G) access. Four male patients aged 23-62 years (mean, 42 years) had 6 migrated stents removed using an existing (n = 3) or new (n = 1) G access. Removed stents included 5 covered esophageal stents that migrated into the stomach and 1 distal noncovered duodenal stent that migrated into the proximal duodenum. One patient had 2 stents removed during the same session. All stents were removed successfully without adverse events. Techniques used included the folding technique using a wire in 3 stents and forceps in 2 stents. Eversion technique was used in the duodenal stent. The G or gastrojejunostomy tubes were replaced after stent removal and used for enteral feedings. In conclusion, removing migrated GI stents using an existing or new G access was technically successful and safe.


Device Removal , Foreign-Body Migration , Gastrostomy , Stents , Humans , Male , Gastrostomy/instrumentation , Gastrostomy/adverse effects , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Foreign-Body Migration/therapy , Foreign-Body Migration/surgery , Middle Aged , Adult , Treatment Outcome , Young Adult
16.
J Cardiothorac Surg ; 19(1): 101, 2024 Feb 19.
Article En | MEDLINE | ID: mdl-38374106

BACKGROUND: Acupuncture, a traditional Chinese medical treatment, has been gaining popularity over the years. However, it also presents certain risks. We report a case of a patient who discovered a foreign body in their lung several years after undergoing acupuncture. CASE PRESENTATION: A middle-aged woman presented to our hospital with chest pain. An X-ray revealed a needle-like foreign body in the middle lobe of her right lung. The patient had previously undergone acupuncture treatment for local pain in her lower back and lower extremities many years prior. Based on the imaging findings and her medical history, we hypothesized that the foreign body in her lung was a result of a dislodged acupuncture needle. Through preoperative 3-dimensional reconstruction and indocyanine green localization, we were able to locate the foreign body in the lateral segment of the right middle lobe. We successfully removed the foreign body via wedge resection, and the patient made a smooth recovery post-surgery. CONCLUSION: Acupuncturists and surgeons should remain vigilant about the potential risks associated with acupuncture.


Acupuncture Therapy , Foreign Bodies , Foreign-Body Migration , Humans , Middle Aged , Female , Needles/adverse effects , Acupuncture Therapy/adverse effects , Foreign Bodies/diagnostic imaging , Foreign Bodies/etiology , Foreign Bodies/surgery , Radiography , Chest Pain , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology
17.
J Vasc Surg ; 79(6): 1369-1378, 2024 Jun.
Article En | MEDLINE | ID: mdl-38316346

OBJECTIVE: There are a variety of methods used today to treat common iliac aneurysms with endovascular techniques. Of these approaches, little is known about whether a particular limb strategy influences endoleak, reintervention, or aneurysm regression rates. We present 5-year data comparing endoleak, stent graft migration, fracture, aneurysm sac dynamics, and aortic rupture rates among patients treated with bell bottom limbs (BB), iliac branch endoprosthesis (IBE), and coil and cover (CC) approaches from the Global Registry for Endovascular Aortic Treatment registry. Secondary end points were all-cause mortality, stroke, reintervention, and paraplegia. METHODS: Subjects from the GORE Global Registry for Endovascular Aortic Treatment were enrolled over a 5-year period from October 2017 to August 2022. We included 924 subjects in this study. Statistical data was generated on R software and limb groups were compared using the Pearson's χ2 test and the Kruskal-Wallis rank-sum test. RESULTS: We found no statistical difference in endoleak rates, stent graft migration, fracture, or aortic rupture when stratified by limb strategy. There was no difference between limb approaches with regard to aneurysm sac dynamics among those with abdominal aortic aneurysms and common iliac aneurysms. Similarly, no statistical difference between limb strategies was found in all-cause mortality, stroke, paraplegia, or reintervention rates. Among patients that required an additional graft during reintervention, the highest rates were found within the IBE group 8.6%, compared with BB group 2.2% and CC group 1.3% (P = .006). CONCLUSIONS: Overall, there was no difference among limb strategies in endoleak rates, stent graft migration, aneurysm sac dynamics, aortic rupture rates, or our secondary end points. Increased rates of reintervention requiring an additional graft within the IBE group is noteworthy and must be weighed against the adverse effects of hypogastric sacrifice with the CC approach or potentially less advantageous seal zones in the BB approach. This finding suggests that all limb approaches have equivalent effectiveness in managing the aneurysmal common iliac artery; thus, the choice of limb strategy should be individualized and remain at physician discretion. Future research should include a more robust sample size to reproduce these findings.


Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Endovascular Procedures , Iliac Aneurysm , Prosthesis Design , Registries , Stents , Humans , Iliac Aneurysm/surgery , Iliac Aneurysm/mortality , Iliac Aneurysm/diagnostic imaging , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/mortality , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Male , Female , Treatment Outcome , Time Factors , Aged , Risk Factors , Endoleak/etiology , Endoleak/surgery , Aged, 80 and over , Aortic Rupture/surgery , Aortic Rupture/mortality , Aortic Rupture/diagnostic imaging , Prosthesis Failure , Retrospective Studies , Risk Assessment , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Abdominal/diagnostic imaging , Foreign-Body Migration/etiology
18.
19.
Dermatol Surg ; 50(5): 453-458, 2024 May 01.
Article En | MEDLINE | ID: mdl-38386847

BACKGROUND: Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. OBJECTIVE: To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. METHODS AND MATERIALS: Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. RESULTS: The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. CONCLUSION: The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.


Cosmetic Techniques , Dermal Fillers , Hyaluronic Acid , Hyaluronoglucosaminidase , Lip , Patient Satisfaction , Humans , Female , Hyaluronic Acid/administration & dosage , Hyaluronic Acid/adverse effects , Retrospective Studies , Dermal Fillers/administration & dosage , Dermal Fillers/adverse effects , Adult , Middle Aged , Hyaluronoglucosaminidase/administration & dosage , Aged , Injections, Subcutaneous , Esthetics , Treatment Outcome , Foreign-Body Migration/etiology
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