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PURPOSE: To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches. METHODS: Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50 years were reviewed. RESULTS: Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening. CONCLUSIONS: Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible.

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El tricobezoar es una masa no digerible de cabellos con restos alimenticios entre otros, que forman concreciones. Se presenta el caso de una adolescente de 15 años de edad con un cuadro clínico de más o menos 2 años de evolución, caracterizado por disminución de peso, se reagudiza hace 2 semanas con nauseas que llegan al vomito. Llega a nuestro servicio, donde se le realiza una tomografía abdominal y una endoscopia, confirmando el diagnostico de tricobezoar gastroduodenal. Se interna a la paciente para manejo nutricional y es intervenida quirúrgicamente. Como hallazgo intraoperatorio se evidencio una ulcera en cara posterior del estómago. Se realizo un manejo conjunto con psiquiatría y nutrición. Se le dio de alta al noveno día postoperatorio, con una evolución favorable, con un control laboratorial más aceptable y con el aumento de 2 kilos. El manejo de estos pacientes debe ser multidisciplinario, buscando que el cuadro no recidive

The trichobezoar is a non-digestible mass of hair with food debris among others, forming concretions. We present the case of a 15-year-old adolescent with a clinical picture of more or less 2 years of evolution, characterized by weight loss, exacerbated 2 weeks ago with nausea and vomiting. She arrives at department, where an abdominal tomography and an endoscopy are performed, confirming the diagnosis of gastroduodenal trichobezoar. The patient was admitted for nutritional management and underwent surgery. Intraoperative findings shower an ulcer in the posterior aspect of the stomach. A joint management with psychiatry and nutrition was performed. She was discharged on the ninth postoperative day, with a favorable evolution, with a more acceptable laboratory control and with an increase of 2 kilos. The management of these patients should be multidisciplinary, ensuring that the condition does not relapse

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A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.

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A hepatic abscess caused by a swallowed foreign body is a rare and challenging diagnosis. Most patients have nonspecific symptoms, and more than 90% of patients do not remember having swallowed it, which occurred accidentally. In this setting, fish bones, chicken bones, and toothpicks are the most found foreign bodies. We reported the case of a 54-year-old male patient admitted with abdominal pain and intermittent fever. He was diagnosed with liver abscess and treated successfully with antibiotics and a laparoscopic procedure; a rosemary twig was found during the abscess drainage procedure. Furthermore, a literature review of 22 cases of laparoscopic treated liver abscesses associated with a foreign body was made.

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Introducción: La litiasis vesical secundaria se forma en el reservorio vesical y requiere la existencia de condiciones patológicas previas como lo son los cuerpos extraños. Objetivo: Describir dos casos clínicos de litiasis vesical secundaria a migración de un dispositivo intrauterino. Caso clínico: Se presentan dos casos de migración intravesical de dispositivo intrauterino con litiasis vesical secundaria. Se diagnosticaron años después de su inserción, ante la aparición de dolor pélvico, cistitis a repetición y hematuria. La laparoscopia no fue útil para su diagnóstico. En consulta de Urología la ultrasonografía y la radiografía de pelvis fueron herramientas diagnósticas útiles ante la sospecha inicial de esta patología. Presentaron buena evolución y regresión total de los síntomas tras cistolitotomía suprapúbica. Conclusión: Se debe pensar en la posibilidad de migración de un dispositivo intrauterino a vejiga ante la cronicidad de síntomas urinarios irritativos bajos en toda mujer que emplee este método anticonceptivo y desconozca su paradero(AU)

Introduction: Secondary bladder lithiasis is formed in the bladder reservoir and requires the existence of previous pathological conditions such as foreign bodies. Objective: To describe two clinical cases of bladder lithiasis secondary to intrauterine device migration. Clinical case report: Two cases of intravesical migration of an intrauterine device with secondary bladder stones are reported. They were diagnosed years after insertion, due to the appearance of pelvic pain, recurrent cystitis and hematuria. Laparoscopy was not helpful for its diagnosis. In Urology consultation, ultrasound and pelvic radiography were useful diagnostic tools in the event of the initial suspicion of this pathology. They showed good evolution and total regression of symptoms after suprapubic cystolithotomy. Conclusion: The possibility of an intrauterine device migration to the bladder should be considered when chronicity of irritative low urinary symptoms in every woman who uses this contraceptive method and which locations are unknown(AU)

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Introducción. La ingestión accidental de cuerpos extraños como espinas de pescado es muy poco frecuente; en ocasiones, pueden alojarse en el esófago y es posible su migración extraluminal. Este accidente se presenta principalmente en países asiáticos por el gran consumo de pescado. La migración extraluminal de una espina de pescado desde el esófago a la glándula tiroides es aún más infrecuente, con pocos reportes en la literatura.Objetivo. Presentar nuestra experiencia en el diagnóstico y manejo quirúrgico de un paciente con un cuerpo extraño (espina de pescado) alojado en la glándula tiroides y, asimismo, hacer una revisión de la literatura científica.Caso clínico. Se presenta una paciente de 53 años, sin antecedentes de importancia y con un cuadro clínico de tres meses de evolución consistente en odinofagia posterior a la ingestión accidental de una espina de pescado. En la ecografía practicada en otra institución se observó un cuerpo extraño alojado en el lóbulo tiroideo izquierdo en relación con la musculatura del esófago. En la tomografía de cabeza y cuello se apreciaba una imagen hiperdensa lineal de 2,6 cm de longitud en la misma localización. En la exploración quirúrgica se encontró tejido fibrótico en la región posterior del lóbulo tiroideo izquierdo y se procedió a practicar una tiroidectomía subtotal izquierda. La evolución posoperatoria fue adecuada.Conclusiones. La migración extraluminal de cuerpos extraños en el tubo digestivo es factible, sobre todo la de las espinas de pescado por su morfología. La tomografía es la herramienta diagnóstica más confiable para detectar cuerpos extraños alojados en la glándula tiroides. Es necesario conocer las posibles complicaciones y, asimismo, optimizar las posibles intervenciones, pues de eso depende el pronóstico clínico del paciente

Introduction: Accidental ingestion of foreign bodies such as fish bones is very rare; sometimes they may lodge in the esophagus, and extraluminal migration is possible. This accident occurs mainly in Asian countries due to the large fish consumption. Extraluminal migration of a fish bone from the esophagus to the thyroid gland is even more infrequent, with few reports in the literature.Objective: To present our experience in the diagnosis and surgical management of a patient with a foreign body (fish bone) lodged in the thyroid gland and to review the scientific literature.Clinical Case: A 53-year-old patient is presented, without a significant history and with a clinical picture of three months of evolution consisting of odynophagia after accidental ingestion of a fish bone. In the ultrasound performed at another institution, a foreign body was observed lodged in the left thyroid lobe in relation to the musculature of the esophagus. Head and neck tomography showed a linear 2.6 cm long hyperdense image at the same location. On surgical exploration, fibrotic tissue was found in the posterior region of the left thyroid lobe and a left subtotal thyroidectomy was performed. Postoperative evolution was adequate.Conclusions: Extraluminal migration of foreign bodies in the digestive tract is feasible, especially that of fish bones due to their morphology. Tomography is the most reliable diagnostic tool to detect foreign bodies lodged in the thyroid gland. It is necessary to know the possible complications and to optimize the possible interventions, since the clinical prognosis of the patient depends on it

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Abstract Hip arthroplasty is a common and safe intervention in orthopedic surgery. However, the proximity of this joint to large vessels makes the occurrence of vascular injury a rare but serious and possibly lethal complication of this surgical technique. Acute vascular injuries in the context of a hip arthroplasty have variable etiologies and clinical presentations, and are more common in revision surgeries and in situations of medial intrapelvic migration and of chronic infection of the hip prosthesis. In the present article, the authors present a case of acute and late major vascular complication in the context of hip arthroplasty revision. The patient developed an acute laceration of the external iliac artery caused by chronic and progressive medial intrapelvic acetabular migration of the hip prosthesis associated with chronic infection.

Resumo A artroplastia da anca é uma intervenção frequente e segura na cirurgia ortopédica. No entanto, a proximidade dessa articulação com vasos de grande calibre faz com que a ocorrência de lesão vascular maior seja uma complicação rara, mas grave e possivelmente letal, dessa técnica cirúrgica. As lesões vasculares agudas no contexto de uma artroplastia da anca têm etiologia e apresentação clínica variáveis e são mais frequentes em cirurgias de revisão e situações de migração medial intrapélvica e de infecção crônica de próteses da anca. No presente artigo, os autores apresentam um caso com complicação vascular maior aguda e tardia em contexto de revisão de prótese da anca. Trata-se de um paciente que desenvolveu uma laceração aguda da artéria ilíaca externa em contexto de migração acetabular intrapélvica crônica progressiva da prótese da anca associada a infecção crônica.

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The use of metal wires, called Kirschner wires, is a simple and effective fixation method for the correction of shoulder fractures and of dislocations in orthopedic surgery. Wire migration during the postoperative follow-up is a possible complication of the procedure. The authors present the case of a 48-year-old male patient, a business administrator, who suffered a fall from his own height during a soccer match resulting in right shoulder trauma. The patient was treated at a specialized orthopedics and trauma hospital and was diagnosed with a grade V acromioclavicular dislocation. Four days after the trauma, the acromioclavicular dislocation was surgically treated using ligatures with anchor wires, coracoacromial ligament transfer, and fixation with Kirshner wires from the acromion to the clavicle. At the follow-up, 12 days after the surgical procedure, migration of the Kirschner wire to the acromion edge was identified. The patient was oriented to undergo another surgery to remove the Kirshner wire, due to the possibility of further migration; nonetheless, he refused the surgery. Nine months after the surgical treatment, the patient complained of pain on the left shoulder (contralateral side), difficulty to mobilize the shoulder, ecchymosis, and protrusion. Bilateral radiographs demonstrated that the Kirschner wire, originally from the right shoulder, was on the left side. The patient then underwent a successful surgery to remove the implant.

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Abstract The use of metal wires, called Kirschner wires, is a simple and effective fixation method for the correction of shoulder fractures and of dislocations in orthopedic surgery.Wire migration during the postoperative follow-up is a possible complication of the procedure. The authors present the case of a 48-year-old male patient, a business administrator, who suffered a fall from his own height during a soccer match resulting in right shoulder trauma. The patient was treated at a specialized orthopedics and trauma hospital and was diagnosed with a grade V acromioclavicular dislocation. Four days after the trauma, the acromioclavicular dislocation was surgically treated using ligatures with anchor wires, coracoacromial ligament transfer, and fixation with Kirshner wires from the acromion to the clavicle. At the follow-up, 12 days after the surgical procedure, migration of the Kirschner wire to the acromion edge was identified. The patient was oriented to undergo another surgery to remove the Kirshner wire, due to the possibility of further migration; nonetheless, he refused the surgery. Nine months after the surgical treatment, the patient complained of pain on the left shoulder (contralateral side), difficulty tomobilize the shoulder, ecchymosis, and protrusion. Bilateral radiographs demonstrated that the Kirschner wire, originally from the right shoulder, was on the left side. The patient then underwent a successful surgery to remove the implant.

Resumo O uso dos fios metálicos, denominados fios de Kirschner, é um método de fixação simples e eficaz para a correção de fraturas e luxações do ombro na cirurgia ortopédica. Uma das possíveis complicações é a migração do fio durante o acompanhamento pósoperatório. Os autores apresentam um caso de um paciente masculino de 48 anos, administrador, que sofreu uma queda de mesmo nível com trauma em ombro direito durante uma partida de futebol. Atendido emumhospital de referência de ortopedia e traumatologia, foi diagnosticada luxação acromioclavicular grau V. Quatro dias após o trauma, fez-se o tratamento cirúrgico da luxação acromioclavicular com amarrilhos com fios de âncora, transferência do ligamento coracoacromial e fixação com fio de Kirchner do acrômio à clavícula. No retorno, 12 dias após o procedimento cirúrgico, identificou-se amigração do fio de Kirschner do bordo do acrômio. Apesar de orientado a se submeter a cirurgia para remoção do fio, o paciente se recusou.Novemeses após o tratamento cirúrgico, o paciente apresentou dores no ombro esquerdo (lado contralateral), dificuldade para mobilizar o ombro, equimose e saliência. Foram feitas radiografias bilaterais e foi constatado que o fio de Kirschner, originalmente no ombro direito, estava no ombro contralateral. Fez-se então cirurgia para remoção do implante, com sucesso.

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La migración intracraneal del aceite de silicona intraocular es una complicación rara en el tratamiento de las complicaciones de la retinopatía diabética. Se han postulado varios posibles mecanismos etiopatogénicos para explicar este fenómeno de migración. El aceite de silicona se presenta hiperdenso en la tomografía, siendo un desafío distinguirlo de la hemorragia subaracnoidea, resaltando la utilidad de la resonancia magnética. En pacientes con evidencia de retinopexia de silicona previa, la visualización de una lesión intraventricular con un artefacto de desplazamiento químico asociado aumenta la posibilidad de que se trate de una migración del aceite de silicona. Presentamos el caso de un paciente con antecedente de retinopexia con aceite de silicona y cefalea intensa, identificándose migración del aceite de silicona al sistema ventricular con estudios de tomografía y resonancia.

The intracranial migration of intraocular silicone oil is a rare complication in the treatment of complications of diabetic retinopathy. Several possible etiopathogenic mechanisms have been published to explain this phenomenon of migration. Silicone oil appears hyperdense on tomography, being a challenge to distinguish it from subarachnoid hemorrhage, highlighting the usefulness of magnetic resonance imaging. In patients with evidence of previous silicone retinopexy, the visualization of an intraventricular lesion with a chemical displacement device presents the possibility that it is a migration of the silicone oil. To present the case of a patient with a history of retinopexy with silicone oil and intense headache, identifying the migration of silicone oil in the ventricular system with tomography and resonance studies.

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Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.

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Introducción. Un bezoar se define como un elemento no digerible atrapado en algún punto del tubo digestivo, el cual puede ser ingerido de forma intencional o accidental. El primer reporte de un bezoar en la literatura médica lo hizo Baudamant en 1779. Caso clínico. Se presenta un caso de un bezoar de plástico, un cepillo dental, como causa de pancreatitis aguda y su manejo por laparoscopia, con una revisión de la literatura. Discusión y conclusiones. Aunque los bezoares gástricos son poco frecuentes, y más aún el de plástico, es importante tenerlos en cuenta como causa de pancreatitis aguda. Definitivamente, el abordaje laparoscópico es el ideal en pacientes sin obstrucción intestinal o inestabilidad hemodinámica

Introduction: A bezoar is defined as an indigestible element trapped somewhere in the gastrointestinal tract, which can be ingested intentionally or accidentally. The first report of a Bezoar in the medical literature was by W. Baudamant in 1779. Case report: We present the case of a plastic bezoar, a toothbrush, as the cause of acute pancreatitis and its management by laparoscopy, and a literature review. Discussion and conclusions: Although gastric bezoars are rare conditions, and furthermore so plastic bezoars, it is important to take them into account as a rare cause of acute pancreatitis. Definitely the laparoscopic approach is ideal for patients without intestinal obstruction or hemodynamic instability

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ABSTRACT Introduction: Among its different therapeutic functions, the use of polymethyl methacrylate (PMMA) for more than a decade has has stood out in the replacement of the volumes lost with the aging process and filling in wrinkles and creases. It is considered a permanent biomaterial despite its reliability is widely discussed by health professionals. Objective: To analyze the size of the microspheres in of three different commercialized types of PMMA, and the inflammatory process generated by the implant, as well as to evaluate possible migration of the microspheres. Methods: The polymers of the brands Biossimetric®, MetaCrill® and Linnea Safe® were analyzed by scanning electron microscope (SEM) and had the dispersion and the size of its particles determined. After this analysis, it was decided to implant in BALB/c mice the polymer of the brand Linnea Safe®, which was the more homogeneous product. The animals submitted to polymer implantation were euthanized at 3, 7, 15, 30, 60, 90 and 120 days after implantation, allowing the weighing of the implanted paws and the histopathological analysis of some tissues. Results: It was observed that the implantation of Linnea Safe® PMMA microspheres in mice triggered an acute inflammatory process 3 to 15 days after the surgical procedure, evolving to chronic non-granulomatous inflammation with collagen deposition, tissue reorganization after 30 days of PMMA implantation up to 120 days; also, no microspheres were observed in distant organs. Conclusion: The Linnea Safe® PMMA behaved as a safe and stable biomaterial, once its microspheres were sized to prevents phagocytosis, and leads to local and controlled inflammation.

RESUMO Introdução: Entre suas diversas funções terapêuticas, há mais de uma década o polimetilmetacrilato (PMMA) vem se destacando na reposição de volumes perdidos com processo de envelhecimento e preenchimento de sulcos e rugas. É considerado um biomaterial permanente, apesar de sua confiabilidade ser amplamente discutida por profissinais da área da saúde. Objetivos: Analisar o tamanho das microesferas de três formas comercializadas de PMMA e o processo inflamatório gerado pelo implante, bem como avaliar a possível migração das microesferas. Métodos: Os polímeros das marcas Biossimetric®, MetaCrill® e Linnea Safe® foram analisados por microscópio eletrônico de varredura (MEV) e tiveram a dispersão e o tamanho de suas partículas determinados. Após essa análise, decidiu-se implantar em camundongos BALB/c o polímero da marca Linnea Safe®, o qual se apresentou mais homogêneo. Os animais submetidos ao implante do polímero foram eutanasiados aos 3, 7, 15, 30, 60, 90 e 120 dias após o implante, permitindo a realização da pesagem das patas implantadas e a análise histopatológica de alguns tecidos. Resultados: Observou-se que a implantação de microesferas de PMMA Linnea Safe® em camundongos desencadeou um processo inflamatório agudo de 3 a 15 dias após o procedimento cirúrgico, evoluindo para inflamação crônica não granulomatosa com deposição de colágeno e reorganização do tecido após 30 dias de implantação de PMMA até 120 dias; além disso, não foram observadas microesferas em órgãos a distância. Conclusão: O PMMA da marca Linnea Safe® comportou-se como um biomaterial seguro e estável, uma vez que as microesferas apresentaram tamanho que impedem sua fagocitose e provocam inflamação localizada e controlada.

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INTRODUCTION AND HYPOTHESIS: Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction. METHODS: A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction. RESULTS: The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI. CONCLUSIONS: Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.

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INTRODUCTION: The ingestion of foreign bodies (FB) is a common problem worldwide and affects all ages; it is, however, particularly important in the pediatric population and in mentally impaired adults. The typical outcome of FB ingestion is good, since the majority of ingested material is passed spontaneously through the gastrointestinal tract. Serious complications can occur, however, including bowel perforation or obstruction and gastrointestinal bleeding, amongst others. Extraluminal migration of ingested foreign bodies is very rare and reported cases so far have shown, more commonly, migration to neck structures, with very few reported cases of migration to the abdomen. To date, there is no reported case of extraluminal migration of ingested FB to the spleen. CASE PRESENTATION: A 59-year-old man presented with acute abdominal pain and dyspnea. A CT scan revealed a FB within the spleen, with a ruptured capsule and perisplenic collection. Surgery was performed and a 3cm-long fishbone was extracted, with hemoperitoneum secondary to spleen rupture. The patient was discharged on the third postoperative day with good recovery and without any complications; pneumococcal polysaccharide vaccination was provided. CONCLUSION: FB ingestion is a relatively benign condition; however, some serious complications can arise infrequently. The patient reported herein is the first in the literature to present a splenic rupture due to extra luminal migration of an ingested fish bone.

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INTRODUCTION: The ingestion of foreign bodies is a frequent occurrence, especially among children. The majority of these objects travel safely through the gastrointestinal tract, without causing symptoms or leaving sequelae. Acute appendicitis is the emergency surgical pathology of greater prevalence. However, the impaction of a foreign body into the appendicular lumen as an etiologic agent of appendicitis is a very rare event. CASE REPORT: We describe the case of a 21-year-old male patient with lower abdominal pain over approximately six days, in association with vomiting, fever and abdominal distension. After imaging studies, a radiopaque foreign body was identified in a pelvic topography, with distention and air-fluid levels in intestinal loops. Our patient was submitted to an open appendectomy, evidencing acute perforated appendicitis and the presence of two foreign bodies in its lumen. The patient progressed satisfactorily in the post-operative period, with use of broad-spectrum antibiotics. DISCUSSION: Foreign bodies impacted in the gastrointestinal tract are usually removed by endoscopic techniques. When these bodies cause infections, there should be a resolution, preferably by surgical laparoscopy, which will serve both for diagnostic as therapeutic purposes. (AU)

INTRODUÇÃO: A ingesta de corpos estranhos é um acontecimento frequente, principalmente entre crianças. A maioria destes passa de forma inócua pelo trato gastrointestinal, sem causar sintomas ou deixar sequelas. Apendicite aguda é a patologia cirúrgica emergencial de maior prevalência. CONTUDO: a impactação de um corpo estranho no lúmen apendicular como agente etiológico de apendicite é um evento muito raro. RELATO DE CASO: Descrevemos o caso de um paciente masculino de 21 anos com quadro de dor abdominal baixa há aproximadamente 6 dias, associando-se a vômitos, febre e distensão abdominal. Após exames de imagem, identificou-se corpo estranho radiopaco em topografia pélvica, distensão e níveis hidroaéreos em alças intestinais. Foi submetido a apendicectomia laparotômica, evidenciando-se apendicite aguda perfurada e presença de dois corpos estranhos em seu lúmen. Evoluiu de forma satisfatória no pós-operatório, tendo-se feito uso de antibióticos de largo espectro. DISCUSSÃO: Corpos estranhos impactados no trato gastrointestinal são usualmente retirados por técnicas endoscópicas. Quando provocam quadros infecciosos, deve-se proceder a uma resolução cirúrgica, preferencialmente por videolaparoscopia, a qual servirá tanto para fins diagnósticos quanto terapêuticos. (AU)

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Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.

A ingestão de corpos estranhos é problema comum nos pronto-socorros e geralmente ocorrem com ossos de aves e espinhas de peixes. Há alguns relatos de casos de migração de corpos estranhos para a retrofaringe, que causam processo infeccioso local, mas não há nenhum caso descrito de espondilodiscite (apesar da proximidade). Talvez a ausência de infecção na coluna vertebral decorra da integridade da fáscia do músculo longo do pescoço, que recobre e protege a coluna cervical. Descrevemos o primeiro caso de espondilodiscite em decorrência de migração de uma espinha serrilhada de peixe que penetrou profundamente na fáscia do músculo longo do pescoço e atingiu o corpo vertebral de C3.

La ingestión de cuerpos extraños es un problema común en los puestos de primeros auxilios y, generalmente, ocurre con huesos de aves y espinas de pescados. Hay algunos relatos de casos de migraciones de cuerpos extraños para la retrofaringe, las cuales causan procesos infecciosos locales, pero no hay ningún caso descrito de espondilodiscitis (aun considerando la proximidad). Quizás la ausencia de infección en la columna vertebral resulte de la integridad de la fascia del músculo largo del cuello, que recubre y protege a la columna cervical. Describimos el primer caso de espondilodiscitis causado por la migración de una espina serrada de pescado, la cual penetró profundamente en la fascia del músculo largo del cuello y alcanzó al cuerpo vertebral de C3.

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Se informa el caso de un hombre residente en la ciudad de Bogotá, Colombia, quien consultó al servicio de urgencias del Hospital el Tunal de dicha ciudad por dolor abdominal progresivo de seis días de evolución, localizado en el cuadrante superior derecho, asociado a ictericia y fiebre, sin antecedentes relevantes. Al ingreso tenía deterioro marcado del estado general, por lo que requirió atención en la unidad de cuidados intesivos; se le hicieron estudios de imágenes diagnósticas que documentaron una colección multiseptada en el lóbulo hepático izquierdo, y un cuerpo extraño. En la laparotomía se encontró un hueso de pescado como causa del absceso. Con el drenaje y la terapia antibiótica la evolución fue favorable.

We report the case of a man who consulted the emergency department of Hospital el Tunal in Bogotá, Colombia, because of six days of progressive abdominal pain in the upper right quadrant, associated with jaundice and fever; there was no relevant information in his medical history. On admission he was found in poor general condition and required management in the intensive care unit; diagnostic imaging studies documented a multiseptate collection in the left hepatic lobe, and a foreign body. He was submitted to laparotomy in which a fish bone was found as the cause of the abscess. After drainage of the collection and with antibiotic therapy evolution was favorable.

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JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi relatar e discutir a experiência clínica de uma doença comum, porém de etiologia pouco frequente com risco de óbito na falta do diagnóstico precoce. RELATO DO CASO: Paciente do sexo feminino, 25 anos, foi admitida no hospital com dor abdominal, febre e calafrios. O exame físico revelou anemia e dor epigástrica. Os dados do laboratório mostraram leucocitose e função hepática alterada. A tomografia computadorizada (TC) de abdômen revelou abscessos no lobo direito e esquerdo do fígado. A laparotomia exploratória foi realizada e uma espinha de peixe de 2,8 cm de comprimento foi encontrada perfurando o duodeno e penetrando no lóbulo esquerdo do fígado formando um abscesso hepático. A drenagem do abscesso hepático com remoção da espinha de peixe e fechamento simples da perfuração foi realizada. A paciente evoluiu bem e recebeu alta hospitalar. CONCLUSÃO: O diagnóstico de abscesso hepático secundário à perfuração do trato gastrintestinal por um corpo estranho é de difícil reconhecimento uma vez que há uma variedade de sintomas inespecíficos e porque os pacientes muitas vezes desconhecem a ingestão. Mesmo assim, na presença de abscessos hepáticos, a etiologia deve ser insistentemente investigada, principalmente quando não responde à terapia inicial. A presença de um corpo estranho deve ser lembrada como possível causa de um abscesso hepático, mesmo que raro, para evitar que se protele o tratamento adequado.

BACKGROUND AND OBJECTIVES: The aim of this study was to discuss the clinical experience of a common disease of infrequent etiology where as death can occur without early diagnosis. CASE REPORT: Female patient, 25 years-old, was admitted with abdominal pain, fever and chills. Physical examination revealed anemia and epigastric pain. Laboratory data showed leukocytosis and abnormal liver function. Computed tomography (CT) of abdomen showed abscesses in the right and left lobe of the liver. Exploratory laparotomy was performed and a fish bone 2.8 cm in length was found perforating the duodenum and penetratingin to the left lobe of the liver forming a liver abscess. The drainage of liver abscess with removal of fish bones and simple closure of perforation was performed. The patient recovered well and was discharged. CONCLUSION: The diagnosis of liver abscess secondary to perforation of the gastrointestinal tract by a foreign body is difficult to recognize since there are a variety of nonspecific symptoms and because patients often unaware of ingestion. Still, in the presence of liver abscess, etiology should be investigated urgently, particularly when not responding to initial therapy. The presence of aforeign body should be remembered as a possible cause of liver abscess, even though rare, to avoid delays the proper treatment.

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A migração de pinos e hastes metálicas ortopédicos para a cavidade torácica é rara e pouco descrita na literatura médica, embora seja potencialmente fatal, principalmente quando atingem o coração ou grandes vasos intratorácicos. Reportamos um caso de migração de fio de Kirschner, implantado na clavícula direita há 10 anos, transfixando a aorta torácica em sua porção ascendente, sendo retirado por toracotomia póstero-lateral esquerda.

The orthopedic metallic pins and wires migration for the chest cavity is uncommon and rarely reported in medical literature although it is potentially lethal, especially when they reach the heart or mediastinum great vessels. We reported a case of Kirschner wire withdrawal, for right postero-lateral thoracotomy, which were transfixanting ascendent thoracic aorta artery, in its due to its migration of left clavicle, where it was placed to fix an occurred fracture 10 years before.

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