Wang Xiaoqing, Wu Xiangyu, Liu Wei, Du Guoqiang, Wang Yanze, Wu Rongde, Guo Feng
Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Front Pediatr. 2023 Jun 23;11:1207247. doi: 10.3389/fped.2023.1207247. eCollection 2023.
Self-insertion of foreign bodies in the urethra is an infrequent occurrence in children, and their management aims to minimize urethral morbidity. Endoscopic removal presents a significant challenge, particularly in boys. Currently, there are few reports on laparoscopic management of urethral foreign bodies that have migrated to the pelvic cavity.
An 11-year-old boy presented to the emergency department with complaints of increased frequency of micturition and dysuria. A sharp sewing needle was discovered lodged in the posterior urethra mucosa during cystoscopy. Attempts to remove the needle using an endoscopic grasping forceps were unsuccessful due to the forceps' weak biting power. During a digital rectal examination, the needle migrated into the pelvic region, wedged between the prostatic urethra and the rectal ampulla. After careful inspection of the peritoneal reflection over the fundus of the bladder, the needle was identified and successfully removed through laparoscopy without any complications. Psychiatric counseling was advised for this patient, who was in good condition during an 8-week follow-up.
Our case demonstrates the first recorded use of laparoscopy to remove a self-inserted urethral needle that had migrated into the pelvic region, after failed attempts at endoscopic extraction. Future cases may benefit from considering laparoscopic interventions for similar circumstances.
儿童尿道内异物自插入情况并不常见，其处理旨在将尿道发病率降至最低。内镜下取出异物极具挑战性，尤其是在男孩中。目前，关于腹腔镜处理已迁移至盆腔的尿道异物的报道较少。
一名11岁男孩因尿频和排尿困难到急诊科就诊。膀胱镜检查时发现一枚尖锐的缝纫针嵌顿在后尿道黏膜中。由于内镜抓取钳咬合力弱，试图用其取出针未成功。直肠指检时，针迁移至盆腔区域，卡在前列腺尿道和直肠壶腹之间。仔细检查膀胱底部的腹膜反折后，识别出针并通过腹腔镜成功取出，无任何并发症。建议对该患者进行心理咨询，其在8周随访期间情况良好。
我们的病例显示，在内镜取出失败后，首次记录了使用腹腔镜取出迁移至盆腔区域的自插入尿道针的情况。未来类似情况的病例可能会受益于考虑腹腔镜干预。
