Endoscopic removal of an impacted acupuncture needle in the duodenum

A 49-year-old Korean woman was admitted to our hospital for treatment of hemorrhoids with intermittent blood-tinged stool since 5 months. She had had cerebral infarction 10 months ago, for which she was treated with traditional Chinese medicine including acupuncture therapy in the facial region. A detailed history could not be taken because of confusion of orientation and aphrasia. Her vital signs were stable, with normal abdominal and chest examination and laboratory tests. However, a hyperdense, linear, pin-like foreign body was incidentally found in the right upper abdominal area in a simple abdominal X-ray performed as part of the preoperative investigation ([Fig. 1]). An abdominal computed tomography (CT) scan showed the foreign body was located in the second portion of the duodenum ([Fig. 2]). Subsequently, a transparent cap-fitted upper gastrointestinal endoscopy revealed a needle-like foreign body embedding into the mucosa of the second portion of the duodenum ([Fig. 3]). The proximal part of the foreign body was firmly grasped with biopsy forceps and slow traction applied into the cap of the endoscope as it was carefully withdrawn ([Fig. 4]). The foreign body was a 6-cm long acupuncture needle consisting of two parts: a 40 × 0.25 mm thin, acupuncture part proximally located at the duodenum and a distally located 20 × 1 mm thick, strap part ([Fig. 5]). There was no significant complication associated with either the presence of the foreign body or the endoscopic procedure. Such cases are extremely rare in the published literature [1] [2] [3].

Fig. 1 Simple abdominal X-ray showing a hyperdense, linear, pin-like foreign body in the right upper abdominal area in an older woman with hemorrhoids and intermittent blood-tinged stool.

Fig. 2 An abdominal computed tomography (CT) scan confirmed the location of the foreign body in the second part of the duodenum.

Fig. 3 Cap-fitted upper gastrointestinal endoscopic view showing a needle-like foreign body embedding into the mucosa of the second part of the duodenum.

Fig. 4 Endoscopic view of the needle-like foreign body being moved into the cap before endoscopic withdrawal.

Fig. 5 The endoscopically removed 6-cm long acupuncture needle.

Endoscopy_UCTN_Code_CCL_1AB_2AF

• References

• 1 Velitchkov NG, Grigorov GI, Losanoff JE et al. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 1996; 20: 1001-1005
• 2 Gracia C, Frey CF, Bodai BI. Diagnosis and management of ingested foreign bodies: a ten-year experience. Ann Emerg Med 1984; 13: 30-34
• 3 Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995; 41: 39-51