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Forgotten Kirschner wire causing severe hematuria.

Kumar S, Singh SK, Jayant K, Agrawal S, Parmar KM, Ajjoor Shankargowda S - Case Rep Urol (2014)

Bottom Line: Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication.Postoperative period was uneventful and patient was discharged in satisfactory condition.Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

ABSTRACT
Kirschner wire (K-wire) is commonly used in the treatment of hip fracture and its migration into pelvis leading to bladder injury is a very rare complication. Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication. We report a case of a patient who presented with acute onset severe hematuria with clot retention secondary to perforation of bladder by a migrated K-wire placed earlier, for the treatment of hip fracture. Initial imaging showed its presence in the soft tissues of the pelvis away from the major vascular structures. Patient was taken for emergency laparotomy and wire was removed after cystotomy. Postoperative period was uneventful and patient was discharged in satisfactory condition. K-wires are commonly used in the management of fracture bones and their migration has been reported in the literature although such migration in the intrapelvic region involving bladder is very rare. Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.

No MeSH data available.


Related in: MedlinePlus

Photograph of the X-ray of pelvis showing the K-wire in the pelvis. A previously inserted copper-T in the uterus is also seen.
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fig1: Photograph of the X-ray of pelvis showing the K-wire in the pelvis. A previously inserted copper-T in the uterus is also seen.

Mentions: A 39-year-old female presented to the emergency department of our institute with complain of acute onset severe hematuria and clot retention. She had a history of lower abdominal pain on and off with dysuria for the last six months. Her medical records revealed that she had undergone open reduction and internal fixation with a K-wire for right hip fracture two years back. The migration of the wire was reported but removal was not performed because patient was lost to followup. At triage the vital signs were as follows: blood pressure: 90/50 mmHg; heart rate: 116 beats/min; respiratory rate: 22 breaths/min; and temperature (oral): 98.2°F. The patient was ill appearing, grimacing in pain, and clutching her lower abdomen. The abdomen was diffusely tender to palpation and more focally in the suprapubic area. Blood was present at the urethral meatus. She was promptly resuscitated with intravenous fluids and blood was sent for laboratory analysis and crossmatching. She was transfused 3 units of blood. Her initial investigation reports revealed Hb: 6 g/dL, TL: 15,000/μL with predominance of neutrophils, platelet count: 150,000/μL, prothrombin time: 16 seconds, and INR: 1.3. Her serum urea was 46 mg/dL, serum creatinine 0.9 mg/dL, and serum blood sugar 104 mg/dL and ABG showed metabolic acidosis (pH—7.30). An emergent ultrasound abdomen was performed which showed ill-defined bladder wall with a large mass of heterogeneous echogenicity, thought to represent clotted blood. Her plain radiograph of pelvis and contrast enhanced computed tomography revealed the left end of the K-wire reaching very close to the medial wall of left acetabulum with right end lying in the soft tissues of the pelvis away from the major vascular structures which appeared normal. There was no perivesical collection (Figures 1 and 2). Later cystoscopy was done which revealed a large bladder clot and a K-wire which was penetrating through the right lateral wall of the bladder and other end was exiting through the left lateral wall with severe inflammatory changes around the sites of penetration (Figures 3(a) and 3(b)). The bladder neck, the trigone, and the ureteric orifices were normal. After initial stabilization patient was taken for emergency laparotomy and implant was successfully extracted after a cystotomy via lower abdominal midline incision (Figures 4(a) and 4(b)). Postoperative period was uneventful. The recovery was unremarkable and patient was discharged on postoperative day 7. She was regularly followed and was doing well.


Forgotten Kirschner wire causing severe hematuria.

Kumar S, Singh SK, Jayant K, Agrawal S, Parmar KM, Ajjoor Shankargowda S - Case Rep Urol (2014)

Photograph of the X-ray of pelvis showing the K-wire in the pelvis. A previously inserted copper-T in the uterus is also seen.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127247&req=5

fig1: Photograph of the X-ray of pelvis showing the K-wire in the pelvis. A previously inserted copper-T in the uterus is also seen.
Mentions: A 39-year-old female presented to the emergency department of our institute with complain of acute onset severe hematuria and clot retention. She had a history of lower abdominal pain on and off with dysuria for the last six months. Her medical records revealed that she had undergone open reduction and internal fixation with a K-wire for right hip fracture two years back. The migration of the wire was reported but removal was not performed because patient was lost to followup. At triage the vital signs were as follows: blood pressure: 90/50 mmHg; heart rate: 116 beats/min; respiratory rate: 22 breaths/min; and temperature (oral): 98.2°F. The patient was ill appearing, grimacing in pain, and clutching her lower abdomen. The abdomen was diffusely tender to palpation and more focally in the suprapubic area. Blood was present at the urethral meatus. She was promptly resuscitated with intravenous fluids and blood was sent for laboratory analysis and crossmatching. She was transfused 3 units of blood. Her initial investigation reports revealed Hb: 6 g/dL, TL: 15,000/μL with predominance of neutrophils, platelet count: 150,000/μL, prothrombin time: 16 seconds, and INR: 1.3. Her serum urea was 46 mg/dL, serum creatinine 0.9 mg/dL, and serum blood sugar 104 mg/dL and ABG showed metabolic acidosis (pH—7.30). An emergent ultrasound abdomen was performed which showed ill-defined bladder wall with a large mass of heterogeneous echogenicity, thought to represent clotted blood. Her plain radiograph of pelvis and contrast enhanced computed tomography revealed the left end of the K-wire reaching very close to the medial wall of left acetabulum with right end lying in the soft tissues of the pelvis away from the major vascular structures which appeared normal. There was no perivesical collection (Figures 1 and 2). Later cystoscopy was done which revealed a large bladder clot and a K-wire which was penetrating through the right lateral wall of the bladder and other end was exiting through the left lateral wall with severe inflammatory changes around the sites of penetration (Figures 3(a) and 3(b)). The bladder neck, the trigone, and the ureteric orifices were normal. After initial stabilization patient was taken for emergency laparotomy and implant was successfully extracted after a cystotomy via lower abdominal midline incision (Figures 4(a) and 4(b)). Postoperative period was uneventful. The recovery was unremarkable and patient was discharged on postoperative day 7. She was regularly followed and was doing well.

Bottom Line: Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication.Postoperative period was uneventful and patient was discharged in satisfactory condition.Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

ABSTRACT
Kirschner wire (K-wire) is commonly used in the treatment of hip fracture and its migration into pelvis leading to bladder injury is a very rare complication. Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication. We report a case of a patient who presented with acute onset severe hematuria with clot retention secondary to perforation of bladder by a migrated K-wire placed earlier, for the treatment of hip fracture. Initial imaging showed its presence in the soft tissues of the pelvis away from the major vascular structures. Patient was taken for emergency laparotomy and wire was removed after cystotomy. Postoperative period was uneventful and patient was discharged in satisfactory condition. K-wires are commonly used in the management of fracture bones and their migration has been reported in the literature although such migration in the intrapelvic region involving bladder is very rare. Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.

No MeSH data available.


Related in: MedlinePlus