Lost Needle during Episiotomy Repair: Case Report.

Azra Kazmi; Atef Elmatary

Abstract

Lost Needle during Episiotomy Repair: Case Report.

Episiotomy during vaginal delivery is a very common and simple surgical procedure; however, this simple procedure can have some uncommon but challenging complications. One such complication is a broken or missing needle during an episiotomy or perineal tear repair. Removal of the needle could be an ordeal especially when the patient is heavily bleeding. Lost/retained foreign surgical object incidents have significant clinical, financial and medico-legal consequences. If it is difficult to find the lost needle immediately, a minimally invasive procedure is desired for a later retrieval. In our case, fluoroscopic guided needle retrieval converted a complicated case into a simple day surgery.

We are presenting a case of Forceps assisted vaginal delivery complicated by traumatic postpartum hemorrhage that became more challenging when the needle got lost during the repair of the actively bleeding episiotomy. To continue the search for the lost needle could have put the patient’s life at risk, whereas leaving the needle behind unaddressed was not ethically the right option. It was decided to secure the hemostasis and leave the needle behind to be removed later. An Interventional Radiologist was involved in the multidisciplinary team and the needle was retrieved successfully under Fluoroscopy guidance and the patient was discharged on the same day. Interventional Radiology is emerging as a very helpful modality to help a surgeon’s decision making in situations where immediate removal of the needle can have devastating effects on the patient’s health and leaving the needle behind can lead to medico-legal problems. If a facility does not have Interventional Radiology services, it is prudent to stabilize and timely transfer the patient to a hospital equipped with such technologies for further management.