Self-Extrusion of Unknowingly Ingested Sewing Needle through the Skin of Neck

doi:10.4236/ijohns.2013.25040

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International Journal of Otolaryngology and Head & Neck Surgery, 2013, 2, 192-194

http://dx.doi.org/10.4236/ijohns.2013.25040 Published Online September 2013 (http://www.scirp.org/journal/ijohns)

Self-Extrusion of Unknowingly Ingested Sewing

Needle through the Skin of Neck

Digvijay Singh Rawat1, Sikandar Singh1, Sudhanshu Pandey1, Tarun Ojh a2, P. C. Verma1

1Department of Otorhinolaryngology, JLN Medical College, Ajmer, India

2Department of Otorhinolaryngology, Mahatma Gandhi Medical College, Jaipur, India

Email: drdigvija[email protected]

Received May 19, 2013; revised June 12, 2013; accepted June 30, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Foreign body ingestion is a common presentation but the extraluminal migration of a foreign body is rare. A 46-year-old

man presented with protruded sharp swelling left side of neck, X-rays and CT scan of the neck showed a needle mi-

grating from the pyriform fossa to the skin. Carotid angiography was also done to see the relations of foreign body with

great vessels. Transcutaneous removal of foreign body was done under general anesthesia. The migrated foreign body

was a sewing needle which patient unknowingly swallowed two days back. Migrated ingested foreign bodies from the

upper digestive tract have the potential to cause life-threatening complications. Cases of spontaneous expulsion of in-

gested foreign bodies to the skin of the neck are quite rare.

Keywords: Foreign Body; Migratory Foreign Body; Ingested Sewing Needle; Transcutaneous Extrusion of Foreign

Body; Self Extrusion of Foreign Body

1. Introduction

Sharp foreign bodies such as fish bones, dentures, wires,

and needles have a tendency to stick in the mucosa of

pharynx and the gastrointestinal tract. Rarer outcomes for

ingested foreign bodies include migration of the foreign

bodies into the soft tissues of the neck [1] or even the

mediastinum [2]. A migrated foreign body has the poten-

tial to cause suppurative as well as vascular complica-

tions [3]. Spontaneous extrusion of an ingested foreign

body via the skin of the neck has rarely been reported.

Commonly migrated foreign bodies reported are fish

bones from the population dependent on sea foods; un-

common are needles, toothpicks, wires, hairpin and den-

tures [3-5]. These have been found at various sites in-

cluding the thyroid gland [6], common carotid artery [7],

and mediastinum [2]. These foreign bodies in the neck

had caused deep neck abscess [3,4], haematoma [3], thy-

roid swelling [6], injury to vessels [3,7,8] and even pseu-

doaneurysm of aorta [7].

A migrated foreign body usually diagnosed with nega-

tive endoscopy with positive radiology cases. Rarely

these cases first present with complication due to migra-

tion. In such situations, a CT scan is necessary to localize

the foreign body and exclude suppurative and vascular

complications [1,4].

2. Case Report

A 46-year-old male patient presented to us with a sharp

protruded swelling left side of the neck for 6 hrs (Figure

1). The protrusion was at the level of cricoid cartilage 1.5

cm left to midline. Patient reported slight pain in throat

for 2 days. Indirect laryngoscopy and telelaryngoscopic

examination was normal and no foreign body could be

visualized. No bleeding spot identified.

PA and lateral skiagram showed presence of radio-

opaque metallic foreign body suggesting a sewing needle

(Figures 2(a) and (b)). The foreign body appeared to be

migrating from left pyriform fossa in the soft tissue of

the neck. Patient recollected the possibility of presence of

sewing needle in some sweets placed on a paper. He

folded the paper and had it directly in his mouth. Patient

has not noticed the presence of needle but experienced

some pain in throat after that.

A contrast enhanced CT scan neck was done to see the

relationship of foreign body to great vessels. CT scan

showed the foreign body tracked medial and distant to

great vessels (Figure 3). As the sharp end of foreign

body was protruding through skin; transcutaneous re-

moval of foreign body was planned. Surgery was done

under general anesthesia. Small incision made at the pro-

trusion site, sharp end of foreign body needle identified

D. S. RAWAT ET AL. 193

Figure 1. Sharp projection by fore i gn body.

(a) (b)

Figure 2. (a), (b) PA & lateral skiagram showing position of

foreign body.

Figure 3. CT scan axial cut showing the path taken by for-

eign body sewing needle from apex of left pyriform fossa to

skin of neck.

in subcutaneous tissue and foreign body was delivered

out gently (Figure 4). Foreign body was a slightly bent

sewing needle of 4 cm length (Figure 5). Single stitch

with 3-0 Ethilon placed to close the wound. Postopera-

Figure 4. Transcutaneous removal of foreign body.

Figure 5. Foreign body sewing needle.

tive recovery was uneventful.

3. Discussion

Foreign body ingestion is a common presentation. Com-

monly children present with foreign body coin ingestion

while in adults usual foreign bodies are fish bone, meat

bolus and dentures. Migration of foreign body usually

takes 24 - 72 hrs and usually are forgotten cases or not

taken seriously by patients or not properly investigated.

Usually migration is noticed after a negative endoscopy

with positive skiagram [4].

Most ingested foreign bodies pass through the gastro-

intestinal tract uneventfully within one week [5]. One of

the uncommon complications of ingested foreign bodies

is migration, which has the potential to cause morbidity

and mortality [4,5].

Chee et al. in a retrospective study found 24 patients

with migrated fish bones in Singapore General Hospital

[4]. Chung et al. presented 4 cases of migrated fish bones

to the neck. In the first case, this caused a recurrent deep

neck infection for 2 years; in the second case, there was

penetration of the facial artery, in third, there was a he-

matoma of the floor of the mouth and in fourth case,

there was a retropharyngeal abscess [3]. Goh et al. re-

ported 4 cases of transesophageal migration of fish bone

into thyroid gland [6]. Migration of ingested foreign

body to mediastinum [2], liver [5], mesentry [9], and

even external iliac vein [10] has been reported. The me-

D. S. RAWAT ET AL.

194

chanism of migration is thought to be due to movement

of neck muscle and viscera during voluntary or involun-

tary movements [11]. Large foreign bodies such as fish

bones, pins or wires are assisted in their migration by

contraction of neck muscle especially the cricopharyn-

geus muscle during swallowing. The shapes of the for-

eign bodies also contribute to the rate of migration [11].

Tan AK et al. have suggested a preoperative CT scan

of the neck before attempting removal of foreign body in

such cases as it tells about the path taken by the foreign

body in migrating to the skin and excludes vascular com-

plications such as a pseudoaneurysm of the great vessels

of the neck, or the foreign body embedded in great ves-

sels, removal of which could trigger a fatal haemorrhage

[1]. CT scan also rules out suppurative complications

such as a deep neck abscess [3].

4. Conclusion

Self-extrusion of a migrated ingested foreign body via

the skin of the neck can be a result of neglected or undi-

agnosed foreign body and is indeed a rare occurrence.

CT scan of the neck helps in early diagnosis of such mis-

placed or suspected foreign bodies and to planning for

surgery. CT also helps in diagnosing any complication

caused by the foreign body migration or impending com-

plication which might occur during removal. Lastly a

foreign body peeping out of the neck should not be pull-

ed casually as fatal complication may occur.

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