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Japanese Immigrant with Abdominal Pain
The Journal of Emergency Medicine, Vol. 52, No. 6, pp. e249–e250, 2017 Ó 2017 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2017.02.017
Visual Diagnosis in Emergency Medicine
JAPANESE IMMIGRANT WITH ABDOMINAL PAIN Joshua McClain, MD* and Zachary D. W. Dezman, MD, MS† *Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland and †Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland Reprint Address: Zachary D.W. Dezman, MD, MS, Department of Emergency Medicine, University of Maryland School of Medicine, 110 Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201
of acupuncture has also been practiced in Korea, Europe, and the United States (1–3). Complications of general acupuncture are pain, bleeding, infections, pneumothorax, and even cardiac tamponade (4,5). Retained needle fragments can cause dermatitis and soft tissue granulomas, though more serious effects have been documented (1). In one report, a patient’s medulla oblongata was pierced by a migrating needle, while another patient suffered both a subarachnoid hemorrhage and spinal nerve compression (6). A third patient had to undergo open-heart surgery to remove a needle that had migrated into their right atrium (6). These needle fragments are often treated as incidental findings in otherwise healthy-appearing patients. It may be beneficial to survey for metallic foreign bodies in the ill-appearing patient with relevant history.
CASE REPORT A 75-year-old female immigrant from Japan presented to the emergency department with the complaint of several years of generalized abdominal pain, worsening over the last several days. She had a history of hypertension, gastroesophageal reflux disease, and an L-2 vertebroplasty. Her skin and abdominal examinations were unremarkable. An abdominal x-ray series revealed dozens of bent metallic fragments in the subcutaneous tissues of the back and abdomen (Figure 1A, B). After further history was obtained from the patient, the patient was discharged with treatment for her presumed reflux and instructed to follow-up with her primary care physician in the next 2 days. DISCUSSION Retained Hari Acupuncture Needles
REFERENCES
Further history revealed the patient had received Hari acupuncture many times in the past. Traditional Chinese acupuncture involves the placement, and later removal, of needles in various anatomical regions. These needles are intended to modify the subject’s ‘‘life energy’’ and relieve them of their ailment. In the Japanese variant called ‘‘Hari,’’ the acupuncturist intentionally breaks the needles off in the subcutaneous tissue of the patient, with the intent of producing a permanent effect (1–3). This style
1. Galbraith PJ, Richardson ML. Permanently retained acupuncture needles: radiographic findings and case report. Radiol Case Rep 2006;1:54. 2. Gerard PS, Wilck E, Schiano T. Imaging implications in the evaluation of permanent needle acupuncture. Clin Imaging 1993;17:36–40. 3. Cathebras P, Dacosta A, Rousset H. [Needles in the heart]. Rev Med Interne 1998;19:137–8. 4. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122–33.
RECEIVED: 5 September 2016; FINAL SUBMISSION RECEIVED: 16 February 2017; ACCEPTED: 25 February 2017 e249
e250
J. McClain and Z. D. W. Dezman 5. Park JE, Lee MS, Choi JY, Kim BY, Choi SM. Adverse events associated with acupuncture: a prospective survey. J Altern Complement Med 2010;16:959–63. 6. Lewek P, Lewek J, Kardas P. An acupuncture needle remaining in a lung for 17 years: case study and review. Acupunct Med 2012;30: 229–32.
Figure 1. (A) Flat anterior-posterior abdomen x-ray image. (B) Arrows highlight some of the bent needle fragments.
http://dx.doi.org/10.1016/j.jemermed.2017.02.017
Visual Diagnosis in Emergency Medicine
JAPANESE IMMIGRANT WITH ABDOMINAL PAIN Joshua McClain, MD* and Zachary D. W. Dezman, MD, MS† *Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland and †Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland Reprint Address: Zachary D.W. Dezman, MD, MS, Department of Emergency Medicine, University of Maryland School of Medicine, 110 Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201
of acupuncture has also been practiced in Korea, Europe, and the United States (1–3). Complications of general acupuncture are pain, bleeding, infections, pneumothorax, and even cardiac tamponade (4,5). Retained needle fragments can cause dermatitis and soft tissue granulomas, though more serious effects have been documented (1). In one report, a patient’s medulla oblongata was pierced by a migrating needle, while another patient suffered both a subarachnoid hemorrhage and spinal nerve compression (6). A third patient had to undergo open-heart surgery to remove a needle that had migrated into their right atrium (6). These needle fragments are often treated as incidental findings in otherwise healthy-appearing patients. It may be beneficial to survey for metallic foreign bodies in the ill-appearing patient with relevant history.
CASE REPORT A 75-year-old female immigrant from Japan presented to the emergency department with the complaint of several years of generalized abdominal pain, worsening over the last several days. She had a history of hypertension, gastroesophageal reflux disease, and an L-2 vertebroplasty. Her skin and abdominal examinations were unremarkable. An abdominal x-ray series revealed dozens of bent metallic fragments in the subcutaneous tissues of the back and abdomen (Figure 1A, B). After further history was obtained from the patient, the patient was discharged with treatment for her presumed reflux and instructed to follow-up with her primary care physician in the next 2 days. DISCUSSION Retained Hari Acupuncture Needles
REFERENCES
Further history revealed the patient had received Hari acupuncture many times in the past. Traditional Chinese acupuncture involves the placement, and later removal, of needles in various anatomical regions. These needles are intended to modify the subject’s ‘‘life energy’’ and relieve them of their ailment. In the Japanese variant called ‘‘Hari,’’ the acupuncturist intentionally breaks the needles off in the subcutaneous tissue of the patient, with the intent of producing a permanent effect (1–3). This style
1. Galbraith PJ, Richardson ML. Permanently retained acupuncture needles: radiographic findings and case report. Radiol Case Rep 2006;1:54. 2. Gerard PS, Wilck E, Schiano T. Imaging implications in the evaluation of permanent needle acupuncture. Clin Imaging 1993;17:36–40. 3. Cathebras P, Dacosta A, Rousset H. [Needles in the heart]. Rev Med Interne 1998;19:137–8. 4. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122–33.
RECEIVED: 5 September 2016; FINAL SUBMISSION RECEIVED: 16 February 2017; ACCEPTED: 25 February 2017 e249
e250
J. McClain and Z. D. W. Dezman 5. Park JE, Lee MS, Choi JY, Kim BY, Choi SM. Adverse events associated with acupuncture: a prospective survey. J Altern Complement Med 2010;16:959–63. 6. Lewek P, Lewek J, Kardas P. An acupuncture needle remaining in a lung for 17 years: case study and review. Acupunct Med 2012;30: 229–32.
Figure 1. (A) Flat anterior-posterior abdomen x-ray image. (B) Arrows highlight some of the bent needle fragments.