Metallic intra-abdominal foreign bodies are an uncommon cause of abdominal pain. They are often diagnosed serendipitously. Foreign bodies have been retrieved from a myriad of locations. However, intra-pancreatic location of such foreign bodies is distinctly unusual. We report the successful retrieval of two metallic pins which were found embedded in the pancreas.

Case Report

A 19 year old boy presented with persistent epigastric pain radiating to the back, of three months duration. The patient denied history of recent jaundice, abdominal trauma and alcohol ingestion, altered bowel habits or recent weight loss. Clinical examination was unremarkable. He was initially evaluated with routine blood tests, serum amylase study and ultrasound study of the abdomen, which were normal. CECT abdomen (Figure 1) revealed the presence of two linear, hyperdense structures in the region of the lesser sac, abutting the body of the pancreas. Barium meal study (Figure 2) clearly delineated the extra-luminal location of the two metallic foreign bodies.

He was subsequently taken up for diagnostic laparoscopy. Since the object could not be localised at laparoscopy, a mini laparotomy was done. Intraoperative fluoroscopy and‘mapping’ of the lesser sac and pancreas aided in the detection of the intra-pancreatic foreign bodies. Two thin (2 mm) metallic pins, each 2 cm long, were found to be embedded in the body of the pancreas at right angles to each other (Figure 3). They could be retrieved with minimal trauma to the pancreatic tissue. Postoperative period was uneventful and the patient was discharged on the seventh postoperative day. The patient was followed up at 3 months and he is doing fine.

Discussion

Although a variety of foreign bodies have been retrieved from intra abdominal viscera, only one case of successful retrieval of intra-pancreatic foreign body has been reported till date.[1] In the above mentioned case, the metallic foreign body was found embedded in the body of the pancreas as a result of penetration from the level of D3. In our case, whether a similar path was the route adopted by the foreign body is a matter of conjecture. Unusual locations of metallic foreign bodies following silent perforation of the viscera include the liver and small bowel mesentery.[2] Intraoperative fluoroscopy and ‘mapping’ of the lesser sac and the pancreas with a non toothed forceps greatly aided in the localisation. Other techniques used for intraoperative localisation of metallic foreign bodies include electronic amplifier devices and magnetic probes.[3,4]

Conclusion

This case report highlights the unusual location of accidentally ingested metallic foreign bodies and the techniques useful in their retrieval. A good history regarding the occupation of a patient who presents with abdominal pain needs to be emphasised here. The patient was working as a technician for air conditioning systems and confessed to biting off pieces of metallic pins and wire, during his job, when retrospectively questioned regarding the same. He has been advised to be cautious while carrying on with his profession.

References