Diagnostic Laparoscopy and Removal of Migrated Orthopedic Hardware

John T. English III, MD, Kurt R. Stahlfeld, MD, Cheryl Six, MD

Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA (all authors).

ABSTRACT

Introduction: Laparoscopic retrieval of orthopedic hardware is rarely documented. We report a case of a diagnostic laparoscopy and successful laparoscopic removal of a migrated retroperitoneal pelvic screw with subsequent resolution of the patient’s pain.

Case Description: A 43-year-old female pedestrian was admitted after being struck by a motor vehicle. Included in her many orthopedic injuries were fractures of the right iliac wing and acetabulum necessitating open reduction and internal fixation using an anterior ilioinguinal approach. Four months after her accident, she presented to the outpatient surgery clinic complaining of pain in the right lower quadrant and a protrusion near the ilioinguinal incision. A plain abdominal radiograph revealed that one of the screws used in pelvic fixation had migrated. A diagnostic laparoscopy to evaluate the protrusion noted laxity without hernia at the iliac crest and a firm mass in the retroperitoneum, consistent with orthopedic hardware. The retroperitoneum was incised and the migrated screw was identified, grasped with a laparoscopic grasper, unscrewed from the pelvis, and removed. She was discharged that day and was pain free on follow-up visits.

Conclusion: The many benefits of laparoscopy in evaluating the peritoneal cavity can safely be extended to removal of orthopedic hardware.

Key Words: Foreign body, Laparoscopy, Orthopedics.

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