Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case.

Jonas P Ehrsam, Olga Meier Adamenko, Rolf B Schlumpf, Othmar M Schöb
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Abstract

Background: Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies.

Methods: We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options.

Results: In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years.

Conclusions: Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.

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胸膜和胰腺中的玻璃异物:系统综述:未解决病例的入口假设和治疗方案
背景:胸膜和胰腺内的异物并不常见,其治疗方法仍存在争议。人们对玻璃异物的了解尤其有限:我们介绍了一例胸膜和胰腺内的大块玻璃碎片,其进入点不明。此外,我们还进行了一项系统性回顾,以探讨入口假说和处理方案:结果:除了我们的病例,我们的综述还发现了八例胸膜内玻璃碎片事件,以及另外八例胸腔内其他部位的玻璃碎片事件。玻璃碎片通过撞击进入体内(81%),撞击后通过膈肌移动(6%),或摄入后造成经食道穿孔(19%)。据记录,有 8 例玻璃进入腹腔的情况,其中 7 例是由于刺入损伤,1 例是由于经肠道移位。没有在胰腺内发现玻璃的记录。在发现的 41 例胰腺内非玻璃异物中,缝衣针(34%)和鱼骨(46%)最为常见;在摄入后,它们通过经胃或经十二指肠穿孔转移。在所有这些病例中,患者对异物是如何进入的往往回忆不清。许多非玻璃异物往往会被纤维组织包裹,使其失去惰性,但这种情况在玻璃异物中并不常见。据报道,玻璃异物会通过各种组织和腔隙迁移,有时甚至会拖延数十年之久。曾有玻璃在胸腔内迁移导致血胸、气胸、心脏和大血管损伤的病例。对于胸腔内玻璃碎片的处理,除我们的患者外,胸腔镜检查在 5 个报道的病例中被证明是有效的。大多数胰腺内非玻璃异物往往会引发胰腺炎和脓肿形成,因此需要进行腹腔镜手术或次全胰切除术。目前仅有四例胰腺内针状物在保守治疗后仍无症状的病例记录在案。现有文献对胰腺内玻璃异物的处理没有直接指导。因此,我们的患者一直在接受观察和定期随访,过去两年来一直没有症状:胸膜内的玻璃异物非常罕见,我们报告的胰腺内玻璃碎片是首例此类异物。玻璃碎片最有可能的进入方式是撞击。由于玻璃具有明显的迁移性和随之而来的并发症可能性,因此应考虑对胸膜内松散玻璃进行预防性取出。不过,胰腺内玻璃碎片的处理仍不确定。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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