A sewing needle migrating from GIT to pancreas!
The present case has been published in the Turkish Journal of Surgery. A 23-year-old female patient presented with epigastric pain and retrosternal burns that continued intermittently for seven years. She had used proton pump inhibitors (PPI) and as her symptoms did not resolve, she presented to the hospital.

In her physical examination, there was minimal tenderness and discomfort in the epigastric area without rebound sign or defense. Her standing abdominal x-ray was also normal (Figure 1a). During gastroscopy, no sign of any pathology related to a foreign body was observed.

A barium follow-through x-ray was performed with an initial diagnosis of gastroesophageal reflux disease, and in this test a foreign body was observed in the epigastric area. When patient’s medical history was questioned again, it was found that she had accidentally swallowed a sewing needle seven years ago.

She underwent CT screening and we saw that a foreign body was present starting from the posterior side of the stomach reaching head and body of the pancreas. She underwent a laparoscopic surgery. During the laparoscopic exploration, the gastrocolic ligament was opened with the help of a laparoscopic instrument.

Foreign metallic body (sewing needle), spanning from the posterior of a small curvature of stomach to the head and body of pancreas was visualized. Using a laparoscopic instrument, the needle was (4 cm) removed from the abdomen in three pieces. The defect in the stomach wall was repaired laparoscopically using 3/0 vicryl sutures.

The patient did not have any postoperative bleeding and she was mobilized 16 h postoperatively. She was started on oral diet on postoperative day four. She was discharged on postoperative day six. During her hospitalization, there was no wound infection or dehiscence.

Learning Points:-
• Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain.

• CT scans provide valuable information for the localization of the lesion, which guides the surgeon during the operation.

• Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen.

• Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time.

Read about the case in detail here: https://pxmd.co/KgATK
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