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East and Central African Journal of Surgery, Vol. 15, No. 1, Mar-Apr, 2010, pp. 144-146 Case Report Missed Foreign Body Presenting as a Chronically Painful Hand. A Case Report S.A. Salati1, T. Rizvi 2, S.M. Rabah1 1Department
of Plastic &Reconstructive Surgery, Code Number: js10025 Missed foreign bodies are common. They may remain asymptomatic or else lead to wide range of complications. We present an 8- years boy who suffered from chronic pain in his right hand case due to a missed foreign body. Introduction Foreign bodies might accidently penetrate the hand and might get missed when patient initially reports. Missed foreign bodies may become symptomatic after varied periods and lead to complications of bones and joints, soft tissue, nerves and blood vessels. The management comprises of accurate preoperative localization and surgical exploration and removal. Case report An 8-years old boy reported with about nine months history of getting pain in right hand on attempting to grip objects like handle of bicycle. There was no other significant past history. On examination, there was a 5 mm scar over the thenar eminence. The parents attributed this scar to injury, which was sustained while playing and managed by self-dressings. X-Rays of the right hand AP (Figure 1 and Figure 2) view showed a radiopaque foreign body on the volar aspect of proximal right hand in relation to carpal bones and carpometacarpal joint. No bony injury was seen. The patient was operated upon under general anesthesia with proximal tourniquet haemostatic control and fluoroscopic guidance. Magnification was achieved with the help of magnifying loupes. A glass piece measuring 11mmx9mmx2mm was recovered (Figure 3). There were no perioperative complications and the patient was asymptomatic and pain free when reviewed three months follow-up. Discussion Accidental penetration of the hand by foreign body is common, especially in children1, 2. The patient may report at the time of injury when foreign body was detected on the basis of history, clinical examination3 and imaging4.. The foreign bodies may however be missed initially, particularly if these are not radio opaque such as thorns and wooden pieces5. A missed foreign body in fact forms a major cause of litigation against emergency physicians6. The patient may remain asymptomatic or with passage of time, develop wide range of complications including pain, abscess, chronic discharging wound, necrotizing fasciitis7, bone and joint destructive lesions1,8,migration9,10, granulomas11, delayed tendon ruptures10,12, neurodeficits9,13,14, and vascular events2 . Accurate preoperative localization is the key to successful surgical removal of foreign body as error at this stage can result in long intraoperative searches and extensive damage to soft tissues15. A foreign body may remain undetected even after thorough exploration5. Conclusion
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