Fractured needle during endoscopic ultrasound-guided fine-needle aspiration of a pancreatic head mass
| Autor: | Shyam Dang, Santiago Andrade Zurita, Alberto Larghi, Fabia Attili, Mihai Rimbaș |
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| Rok vydání: | 2015 |
| Předmět: |
Endoscopic ultrasound
medicine.medical_specialty Duodenum Pancreatic head Duodenal bulb medicine Humans Sampling (medicine) Plastic stent Endoscopic Ultrasound-Guided Fine Needle Aspiration Aged Pancreatic duct medicine.diagnostic_test business.industry Gastroenterology Pancreatic Diseases Foreign Bodies Surgery medicine.anatomical_structure Fine-needle aspiration Needles Biliary stent Equipment Failure Female Radiology business |
| Zdroj: | Endoscopy. 47 |
| ISSN: | 1438-8812 |
| Popis: | Endoscopic ultrasound (EUS)-guided fineneedle aspiration (FNA) is a safe procedure with a low complication rate [1]. To the best of our knowledge, there has only been one previous report of inadvertent fracturing of an FNA needle, which occurred during an attempted EUS-guided rendezvous for an inaccessible main pancreatic duct [2]. We present the case of a 75-year-old woman with an unresectable pancreatic head mass, who was referred to us for EUS-FNA after biliary stent placement. The procedure was performed by an experienced endosonographer from the duodenal bulb using a 22-gauge needle. The needle was inserted into the periphery of the mass to avoid passing through the plastic stent, and the fanning technique was used. At the end of the first pass, an unusual hyperreflecting line was observed, corresponding to the needle tract (●" Fig.1), which suggested that the needle may have broken during the sampling procedure. This was confirmed when the needle was advanced outside the external sheath to collect the specimen. The extremity of the broken needle was further identified protruding from the mucosa of the upper duodenal bulb (●" Fig.2). After various attempts at retrieval, the needle was grasped from the terminal end using a snare and was removed completely, without any consequences to the patient. The needle segment measured 4 cm (●" Fig.3,●" Video 1). There was no obvious cause of this incident. However, it is possible that the plastic stent could have been a relevant factor in the breaking of the needle. This case highlights the importance of ensuring that the correct EUS-FNA procedure is followed. After confirmation of a needle fracture, endoscopic removal can be accomplished with caution using the proper endoscopic accessories, in order to avoid potential damage to both the patient and the echoendoscope. |
| Databáze: | OpenAIRE |
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