Breakage of the needle and missing while repairing the uterine wound during cesarean section is an uncommon event. Subsequently it was removed under fluoroscopic guidance on the 7th postoperative da

Das, Chandana

Mukherjee, Gautam

Naskar, Animesh

Pati, S

English

CogPrints Cognitive Sciences Eprint Archive

Missing Broken Needle During Caesarean Section

Cognitive Sciences ePrint Archive

Peer Reviewed, Open Access, Free
Published Quarterly
Mangalore, South India
ISSN 0972-5997
Volume 8, Issue 2; Apr-Jun 2009
Missing Broken Needle During Caesarean Section
Authors
Chandana Das, Associate Professor, 
Gautam Mukherjee, Assistant Professor,
Pati S, Professor
Animesh Naskar, Resident Medical Officer,
Dept of G & O, North Bengal Medical College, Darjeeling, West Bengal.
Address For Correspondence
Dr. Chandana Das,
P 232 C, CIT Road
Scheme VI M, Kolkata - 700054
West Bengal, India.
E-mail: dasc54@yahoo.com
Citation
Das C, Mukherjee G, Pati S, Naskar A. Missing Broken Needle during Caesarean Section. Online J Health Allied Scs.  
2009;8(2):12
URL
http://www.ojhas.org/issue30/2009-2-12.htm 
http://ojhas.org 1
OJHAS Vol 8 Issue  2(12)   Das C, Mukherjee G, Pati S, Naskar A. Missing Broken Needle during Caesarean Section
 Case Report
Submitted: Jun 10, 2009; Accepted: Jul 25, 2009 Published: Sep 8, 2009
Abstract:
Breakage of the needle and missing while repairing the uterine wound during cesarean section is an uncommon event. 
Subsequently it was removed under fluoroscopic guidance on the 7th postoperative day.
Key Words: Broken Needle, Foreign body, Caesarean section
Introduction:
Foreign bodies retained in the peritoneal cavity rarely 
are  documented,  owing  to  medical,  legal  and  other 
reasons. Each such incident acquires major importance 
because it upsets patients, relatives, surgeons, hospital 
room staff and the hospital administrator. They may be 
symptomatic or remain asymptomatic for months and 
years  and  removed  incidentally.  The  present  report 
concerns  one  patient  with  intra  abdominal  foreign 
body  (broken  surgical  needle  left  behind  during 
cesarean section) which was retrieved successfully on 
7th postoperative day.
Case Report:
A 30 years old lady, Para 2+0 was admitted at North 
Bengal Medical College Hospital (NBMCH) as a re-
ferred case from a peripheral hospital where an Emer-
gency caesarean Section was done at  term two days 
earlier,  indicated as a result of a previous Caesarean 
section  and  severe  Pregnancy  Induced  Hypertension 
and scar tenderness. According to the referral  paper, 
while repairing the uterine wound during cesarean sec-
tion, the needle was broken and in spite of thorough 
search the surgeon could not find it out and completed 
the operation and referred her to NBMCH. On admis-
sion her general condition was very poor with severe 
anemia, haemoglobin being 6 gm% and blood pressure 
180/100  mm  Hg.  The  relatives  were  very  much 
anxious and concerned about the retained needle in the 
abdomen.  Her  general  condition  was  improved  by 
transfusing  4 units  of  blood.  She  was  put  on broad 
spectrum antibiotics and other supportive measures in-
cluding antihypertensive namely Tablet Labetalol. All 
necessary  investigations  were  done  including  a 
straight X-ray PA and lateral view of lower abdomen 
and pelvis which clearly demonstrated the presence of 
a broken needle in the abdomen; however its precise 
location could not be established even by ultrasono-
gram. After proper counseling on the 7th post operative 
day,  laparotomy was  performed.  Under  fluoroscopic 
guidance  the  needle  was  located  deep  inside  the 
myometrium near the left angle of the uterine wound. 
Incision  was  made  on  the  myometrium  and  it  was 
deepened gradually until an artery forceps hit the em-
bedded  needle  and  a  portion  of  it  became  visible 
which was then removed. The uterine wound was re-
paired and the abdomen was closed in layers. Post op-
erative period was uneventful and she was discharged 
home in satisfactory condition on the 10th post operat-
ive day.
Discussion:
Retained foreign body (RFB) following cesarean sec-
tion is not common and reported variedly in the literat-
ure. The commonest RFB is the surgical  sponge.1 In 
spite of all precautions, mistakes do occur resulting in 
various complications with considerable suffering for 
the patients. It may remain asymptomatic for months 
and years and removed accidentally.2
Some times diagnosis of RFB is difficult, and at times 
it is difficult to retrieve it at laparotomy,3 particularly 
for a small object like needle. In our case the diagnosis
Fig. I Straight X-Ray of Abdomen and Pelvis show-
ing a Leftover broken surgical needle.
 of RFB was no problem as the patient was sent with a 
note of a retained broken needle which could not be 
retrieved during cesarean section by the surgeon. This 
was because of the poor general condition of the pa-
tient  which  compelled  him  to  close  the  abdomen 
quickly  without  getting  adequate  time  for  thorough 
search for the needle. Though the presence of a needle 
in the pelvis was confirmed by X-ray later on, its pre-
cise  location could not  be identified  easily until  the 
help of peroperative fluoroscopy (C-Arm ) was taken 
which showed that the needle was embedded deep in 
the myometrium near the left angle of uterine wound. 
Some times in long standing cases RFB are surroun-
ded by gut and fistulas may occur and may even mi-
grate  to  other  organs  like  intestine,  urinary bladder 
etc., making retrieval difficult.4,5 Very rarely a tumour 
like  thing may develop  with  the  FB as  nidus along 
with  the  adherent  gut  and  omentum and  discovered 
only after resection and removal of the mass at laparo-
tomy.2 According to some, removal of  foreign bodies 
like needle or small part of surgical items may cause 
more harm than the item itself and removal is not re-
commended.  6 But it is very difficult to translate this 
recommendation practically.  As the patient as well as 
the relatives are very much worried about the left over 
needle  in  the  abdominal  cavity,  and  also  from  the 
medicolegal  point  of  view,  removal  is  preferred  in 
spite of difficulty. 
http://ojhas.org 2
OJHAS Vol 8 Issue  2(12)   Das C, Mukherjee G, Pati S, Naskar A. Missing Broken Needle during Caesarean Section
One should take utmost care to avoid RFB to occur at 
all. Recently, New England Journal of Medicine pub-
lished an article about risk factors of RFBs. Of the 8 
risk factors  the authors identified (emergency opera-
tion, unexpected change in operation, more than one 
surgical team involved, change in nursing staff during 
procedure, body mass index (BMI), volume of blood 
loss,  female  sex,  and  surgical  counts)  only  3  were 
found to be statistically significant. The 3 significant 
risk  factors  were  emergency  surgery,  unplanned 
change in the operation, and BMI.7 Proper counting of 
instruments / sponges repeatedly by different members 
of the team can prevent RFB to a great extent. New 
technologies  are being developed that will  hopefully 
decrease the incidence of RFB. An electronic article 
surveillance system has been examined which uses a 
tagged surgical sponge that can be identified electron-
ically.8  Bar codes can be applied to all sponges, and 
with the use of a bar code scanner the sponges can be 
counted on the back table. The use of radiofrequency 
identification systems holds much hope for application 
in the area of detection of sponges.6
Conclusion:
As surgery is a team work, preventing RFB is also a 
team  work;  every  member  in  the  team  including 
nurses should make conscious effort in this direction, 
abiding recommendations, more so in high risk cases, 
thereby preventing mortality and morbidity of the pa-
tients and averting litigations.
References:
1. Mirsharifi R, Aminian A, Jafarian A, Kalhor 
M,  Dashti  H,  Ali  FAH,  Alibakhshi  A, 
Tahvildary  M,  Heidari  S,  Tavakoli  F  .Re-
tained Foreign Body,  Brief Review.  Shiraz 
E-Medical Journal. 2008;9(4)
2. Rodriguez GR, Mano DL, Rodriguez R et al. 
Intra-abdominal  Foreign  Body  19  Years 
After a Cesarean Section.  Journal of Pelvic  
Medicine & Surgery. 2008;14(6):437-40
3. Revesz G, Siddiqi TS, Buchheit WA, Bonit-
atibus  M.  Detection  of  retained  surgical 
sponges. Radiology. 1983;149: 411-413.
4. Gupta NM, Chaudhary A, Nanda V, Malik 
AK, Wig JD. Retained surgical sponge after 
laparotomy:  Unusual  presentation.  Disease 
of the colon and rectum. 1985;28:451- 53
5. Tomás Lázaro Rodríguez Collar, Yamel Gil 
del Valle, Basily Valdés Estévez, Víctor Os-
valdo Barquín Carmona, José Antonio Gar-
cía Monzón.  Bladder lithiasis secondary to 
intrauterine  device  migration.  Case  report. 
Arch Esp Urol. 2008;61(5):640-3
6. Gibbs  VC,  Coakley  FD,  Reines  HD.  Pre-
ventable  errors  in  the  operating  room:  re-
tained  foreign  bodies  after  surgery.  Curr 
Probl Surg. 2007;44:281-337.
7. Gawande AA, Studdert DM, Orav EJ, Bren-
nan TA, Zinner MJ. Risk factors for retained 
instruments  and  sponges  after  surgery.  N 
Engl J Med. 2003;348:229-235.
8. Fabian  CE.  Electronic  tagging  of  surgical 
sponges to prevent their accidental retention. 
Surgery. 2005;137:298-301.
http://ojhas.org 3
OJHAS Vol 8 Issue  2(12)   Das C, Mukherjee G, Pati S, Naskar A. Missing Broken Needle during Caesarean Section


Detection of retained surgical sponges.

Electronic tagging of surgical sponges to prevent their accidental retention.

Intra-abdominal Foreign Body 19 Years After a Cesarean Section.

Preventable errors in the operating room: retained foreign bodies after surgery. Curr Probl Surg.

Retained surgical sponge after laparotomy: Unusual presentation. Disease of the colon and rectum.

Risk factors for retained instruments and sponges after surgery.

Tomás Lázaro Rodríguez Collar, Yamel Gil del Valle, Basily Valdés Estévez, Víctor Osvaldo Barquín Carmona, José Antonio García Monzón. Bladder lithiasis secondary to intrauterine device migration. Case report. Arch Esp Urol.

Chandana Das

Gautam Mukherjee

Pati S

Animesh Naskar

Directory of Open Access Journals

http://doaj.org/search?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22id%22%3A%22647037927ff247aa89beb7b92ac43a7f%22%7D%7D%5D%7D%7D%7D

Missing Broken Needle During Caesarean Section

Abstract

Similar works

Full text

Available Versions

CogPrints Cognitive Sciences Eprint Archive

Cognitive Sciences ePrint Archive

Directory of Open Access Journals