背景:胸膜和胰腺内的异物很少见,他们的治疗方法仍然是一个争论的话题。特别是关于玻璃异物的知识有限。
方法:我们介绍了一个涉及胸膜和胰腺大玻璃碎片的病例,一个未知的入口。此外,我们进行了系统回顾,以探讨进入假设和管理选择.
结果:除了我们的案例,我们的审查发现了8例胸膜内玻璃,另外8例其他胸内区域的玻璃。碎片通过刺穿进入身体(81%),刺穿后迁移通过隔膜(6%),或导致食入后食道穿孔(19%)。记录了8例腹腔内的玻璃,七个是由于穿刺损伤造成的,一个是经肠迁移造成的。在胰腺内没有发现玻璃的记录。在发现的41个非胰腺内异物中,缝纫针(34%)和鱼骨(46%)是最常见的;摄入后,它们通过经胃或经十二指肠穿孔迁移。在所有这些情况下,患者通常很难回忆起异物是如何引入的。许多非玻璃异物往往被纤维组织包裹,使它们变得惰性,虽然这在玻璃上并不常见。据报道,玻璃可以通过各种组织和空腔迁移,有时甚至会持续几十年。有玻璃胸膜内迁移导致血胸的病例,气胸,心脏和主要血管损伤。对于胸膜内玻璃碎片管理,胸腔镜在5例报道的病例中被证明是有效的,除了我们的病人。大多数胰腺内异物倾向于引发胰腺炎和脓肿形成,需要从腹腔镜手术到胰腺次全切除术的管理。只有四例记录的胰腺内针在保守治疗下保持无症状。现有文献没有关于胰腺内玻璃异物管理的直接指导。因此,我们的患者正在接受定期随访,过去2年一直无症状.
结论:胸膜中的玻璃异物很少见,我们关于胰腺内玻璃碎片的报道是首例。穿刺是最可能的引入方法。由于玻璃具有明显的迁移和随之而来的并发症潜力,应考虑预防性切除胸膜内松动的玻璃。然而,胰腺内玻璃碎片的管理仍然不确定。
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.