Abstract
The patient in our case was a 64-year-old woman who underwent medical examination in our outpatient clinic. She chiefly complained of upper abdominal pain and fever. On questioning her and recording her clinical history, we found that she had swallowed needles in an attempt to commit suicide approximately 1 month previously. Abdominal contrast-enhanced computed tomography (CT) detected 2 needle-like foreign bodies (each 5 cm long) in the abdomen. One of them penetrated the portal vein and crossed the duodenal bulb ; this penetration was accompanied by a thrombus in the portal vein. The other needle was found near the ascending colon in the abdomen. We urgently performed upper gastrointestinal endoscope operation and evulsed the needles in the portal vein on the same day. At a later date, we laparoscopically removed any residual needle in the abdomen. Thereafter, we conducted a surgery under fluoroscopic guidance and confirmed the absence of any residual needle in the abdomen. We could not identify any apparent perforated site. The patient's condition steadily improved after the surgery. She was administered warfarin for the treatment of the thrombus in the portal vein. We encountered a case of a patient who had attempted suicide by swallowing needles that penetrated the abdomen and portal vein. We could safely remove the needles endoscopically and laparoscopically. We report here, with bibliographic consideration, the first case in Japan of a patient who swallowed needles that penetrated the portal vein.
