Pointed in the Wrong Direction: The Case of a Missing Needle

Objectives: This surgical video aims to highlight the diagnostic and surgical challenges encountered in the management of a 13-year-old female presenting with lower abdominal pain and hematuria, ultimately diagnosed with a needle lodged in her bladder. The objectives include illustrating the importance of a sequential diagnostic approach, surgical precision in foreign body removal, and the critical role of clinical judgment in navigating complex cases.

Methods: The case presentation outlines the patient's initial symptoms, diagnostic workup, and subsequent surgical intervention. Imaging studies initially suggested the presence of the foreign body in the uterine myometrium, leading to a referral to a tertiary care center. Upon arrival, the patient underwent an examination under anesthesia followed by hysteroscopy and cystoscopy for localization and removal of the foreign body. Surgical techniques and decision-making processes during the procedure are detailed to demonstrate the challenges faced and the strategies employed.

Clinical Relevance: This video underscores several key clinical points relevant to healthcare professionals managing patients with suspected genitourinary foreign bodies. Firstly, it highlights the diagnostic difficulties associated with atypical presentations and the limitations of relying on imaging modalities. Secondly, it emphasizes the importance of surgical precision in foreign body removal to minimize iatrogenic injuries and complications. Additionally, the case illustrates the value of a sequential approach to diagnosis and treatment, starting with less invasive procedures such as cystoscopy before considering more extensive interventions like laparoscopy. Furthermore, it emphasizes the crucial role of clinical judgment and adaptability in guiding patient management, particularly in challenging surgical scenarios. This case serves as a reminder of the need for comprehensive evaluation, meticulous surgical technique, and patient-centered care in optimizing outcomes for patients with foreign genitourinary bodies. It provides valuable insights and practical lessons for healthcare professionals facing similar diagnostic and therapeutic dilemmas, ultimately contributing to improved patient care and safety.