Let’s take a side note here and start a new series. This one will be out every other Friday and (it may make you cringe, laugh or look on in horror at times) will talk about injuries. Injuries are common in every craft; you burn your self with a hot glue gun, accidentally drink your paint brush water (yes that’s an injury to your taste buds and maybe your insides depending on old it is). And we’ve all pricked our finger on a needle, but, here’s the thing did you ever imagine you’d get your crochet hook stuck in the roof of your mouth? How about a perforation of the bladder or brain? No, me neither. That’s real and I’m going to spend the coming weeks telling you all about it. These are not your carpal tunnel type Injuries and they aren’t your grandmother injuries either. So whether you say WTF or immediately have to consider what these people were doing to come by these injuries I hope it will make you come back and take a look at the next one.
We will begin out series (in no particular order) with case sent to Dr. Henry Roth, in May 12, 1929 while he was at Lebanon Hospital, New York. The patient is a female, aged fourteen who several hours before admission attempted to bring on her menstrual flow by introducing a
crochet needle 12 cm. long into the vagina. She was advised to do this by one of her school mates who warned her of the possibility of becoming pregnant in the event that the menstrual flow had not started. Pause for that consideration.
The needle suddenly disappeared after it was introduced into the vagina. She immediately experienced some pain in the suprapubic region and slight pain on urination. There was no increased frequency of urination and no hematuria. On physical examination the patient appeared very small and emaciated. In the suprapubic region there was very little tenderness and no rigidity. There was no bleeding from the vagina which admitted two fingers very easily and without eliciting any pain. Through the anterior vagina wall there was felt about 4 cm. of a long hard object, lying transversely and firmly fixed; while this foreign body was palpated at which point she complained of pain….
An x-ray examination disclosed a crochet needle in the region of the bladder lying in an oblique position with the point end downward towards the right and posteriorly. The following morning a cystoscopy was done under sacral anesthesia. The Brown Buerger cystoscope was easily introduced. The crochet needle was found lying transversely in the bladder with the point embedded in the mucosa just above and to the right of the right ureteral orifice. The blunt end was embedded in the left side and nearer the posterior superior aspect of the bladder. This end was more difficult to visualize. The name and number on the needle was easily read, so
that a duplicate was obtained to determine the actual size. The bladder mucosa was slightly congested. The needle was easily grasped near its point with the cystoscopic forceps, but every attempt to extract it failed.
The patient suddenly complained of abdominal pain and simultaneous with this the object could no longer be located in the bladder. On examination the abdomen was found very tender and rigid all over. The needle could not be palpated any longer through the anterior vaginal wall. It was now obvious that the needle perforated the bladder and was lying free in the abdominal cavity. An immediate x-ray disclosed some change in position compared to the previous film. Immediate operation was done; through a suprapubic median incision, the peritoneal cavity was opened; the needle was found lying free in the left iliac region and removed; there was no peritoneal contamination. A small perforation was found on the left side of the bladder on the posterior surface. This was closed by a small purse string plain catgut suture through serous and muscular coat and reinforced by two interrupted sutures through muscle and serosa only. A Penrose tube was left in the pelvis for drainage and the abdomen was closed in layers. Her convalescence was uneventful. The drain was removed on the fifth day and the patient was discharged on the twelfth day after operation.
Cystoscopy just before her discharge from the hospital disclosed a normal looking bladder except for two small healing ulcers which corresponded to the areas where the points of the needle were firmly embedded in the mucosa through muscle and serosa only. A Penrose tube was left in the pelvis for drainage and the abdomen was closed in layers. Her convalescence was uneventful. The drain was removed on the fifth day and the patient was discharged on the twelfth day after operation.
Cystoscopy just before her discharge from the hospital disclosed a normal-looking bladder except for two small healing ulcers which corresponded to the areas where the points of the needle were firmly embedded in the mucosa.
The most common variety of foreign bodies one encounters in the urinary bladder consists of rubber and ureteral catheters, straws, chewing gum and hair pins. Think that through and join us in two weeks for another episode of WTF Where you thinking.