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The localization and removal of a superficial foreign body is a common challenge that emergency physicians encounter. The
use of ultrasonography to detect superficial foreign bodies has been well documented, but with varying success. This case
report demonstrates the use of a finder needle, placed under ultrasound-guidance, to assist in the localiz...
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Citations
... %20Technical%20Note%20video.mp4?dl = 0 DISCUSSION Currently reported intraoperative localisation techniques include fluoroscopy and intraoperative ultrasound, with associated problems being irradiation and inexact localisation, and operator expertise, respectively. 1,4 Sentimag was developed to localise magnetically susceptible markers inserted preoperatively to, in turn, localise impalpable breast tumours and sentinel lymph nodes intraoperatively. 2,3,5 In the context of foreign body retrieval, real-time feedback and the ability to alter the probe angle and distance within the wound allow for precise siting of the skin incision (if required) and foreign object localisation during dissection. ...
Background
Emergency physicians frequently evaluate patients with postoperative wound issues. The differential is broad, but obviously includes postoperative site infections. We present a case where a suspected postoperative abscess was evaluated with bedside ultrasound prior to incision and drainage. Suture material was recognized, shifting our approach to treatment of the lesion.
Case Report
A 24-year-old female patient presented with pain, swelling, and drainage from a left lower quadrant abdominal wound that had been present since undergoing a laparoscopic appendectomy 1 year prior. A computed tomography scan was performed, which was negative for foreign bodies. Prior to incision and drainage, a bedside ultrasound was performed to evaluate the lesion, which was notable for sonographic findings consistent with suture material. Suture granuloma was diagnosed, and ultrasound was then used to successfully guide retrieval of the suture. To our knowledge, this is the first published case where ultrasound was used to both diagnose and dynamically remove the offending suture material. We briefly discuss suture granulomas, their sonographic appearance, and management.
Why Should an Emergency Physician Be Aware of This?
Emergency physicians frequently perform ultrasound on suspected abscesses prior to incision and drainage and should be aware of the sonographic appearance of suture material as it would change management if present. If a suture granuloma is suspected due to swelling at a postoperative site, ultrasound use should be strongly considered for evaluation.
