///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Case of the Missing Needle

Abstract Number: 239
Abstract Type: Case Report/Case Series

Anup Pamnani M.D.1 ; Anup Pamnani M.D.2; Panchali Dhar M.D.3; Farida Gadalla M.D.4

CASE REPORT

The Case of the Missing Needle

Pamnani A. MD, Dhar P. MD, Gadalla F. MD

Department of Anesthesiology

Weill Cornell Medical College

New York-Presbyterian Hospital

New York, New York

The patient was a 41 year old patient in active labor.

An epidural was placed at L2-3 using a 17 gauge Hustead needle, and a 19 gauge Duraflex plus multi-lumen epidural catheter was threaded easily and taped to the skin at 12 cm without complications. Labor analgesia was accomplished. Several hours later, the decision was made to proceed to cesarean section.

Surgical anesthesia was obtained using the labor epidural catheter and a routine cesarean section ensued. Towards the end of the surgery, a count revealed a Polysorb GS-21 2-0 suture needle was missing.

Abdominal X-rays were obtained in the operating room to rule out a retained needle. The AP film showed an opacity in the midline consistent with the size and curvature of the needle (2cm tip to base).

After consultation with the radiologist, a diagnosis of "retained foreign object" was made. The surgeon requested re-dosing the epidural catheter to perform abdominal exploration and needle removal.

On re-evaluation by the anesthesiologist, it was noted that the object in question was overlying the radioopaque epidural catheter at the L2-3 level.

The anesthesiologists then considered the possibility that the opacity might represent artifact and actually be part of the epidural catheter rather than a needle. The options for the differential diagnosis included:

1. Injecting radio-opaque dye into the epidural catheter to determine if the curved portion filled uniformly.

2. Removing the catheter and repeating the x-ray to see if the "needle" disappeared. This however, would entail reinforcing the epidural prior to removal in case a re-exploration was indicated and might necessitate a second anesthetic.

3. Pulling the catheter back while still ensuring the epidural catheter remained in the space and repeating the x-ray.

The team chose the third option. An x-ray was taken and the artifact, which was of the same dimensions as the needle, proved to be a portion of the epidural catheter.

The needle was never found, and a repeat x-ray after completion of the cesarean section and removal of the epidural catheter revealed no intra-abdominal foreign objects.

ADDITIONAL radiographs will be submitted if poster accepted.



SOAP 2009