An Unusual Presentation of Foreign Body in the Common Carotid Artery - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/233830626 An Unusual Presentation of Foreign Body in the Common Carotid Artery Article in Indian Journal of Surgery · December 2011 DOI: 10.1007/s12262-011-0257-y · Source: PubMed CITATIONS READS 2 28 4 authors , including: Udayan Bakshi Woodlands Multispeciality Hospital Limited, Kolkata, India 2 PUBLICATIONS 2 CITATIONS SEE PROFILE All content following this page was uploaded by Udayan Bakshi on 10 December 2019. The user has requested enhancement of the downloaded file.

Indian J Surg (November – December 2011) 73(6):460 – 462 DOI 10.1007/s12262-011-0257-y CASE REPORT An Unusual Presentation of Foreign Body in the Common Carotid Artery Somdatta Lahiri & Shibajyoti Ghosh & Goutam Sengupta & Udayan Bakshi Received: 22 January 2009 /Accepted: 23 May 2009 /Published online: 19 April 2011 # Association of Surgeons of India 2011 Abstract Penetrating trauma to neck resulting in arterio- Case report venous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening con- A 25 year old scrap factory worker presented to us with a sequences. We report here a case of a young factory worker painless, gradually increasing swelling in the right side of who developed a traumatic AV fistula with false aneurysm, his neck, following injury by a penetrating metallic splinter with however, no other complications. He was successfully two months back. He had no other complaints. operated when he presented to us two months after the He did not give any history of bleeding from the nose or injury and is doing well in follow-up. ears, problems with vision or any sensory or motor deficit during this two month period. There was also no history of Keywords Penetrating neck injury. AV fistula of the increasing breathlessness, cough, change in voice. carotid artery and internal jugular vein (IJV) . Local examination revealed a 3×2 cm firm, pulsatile Pseudoaneurysm of common carotid artery swelling in the right side of his neck at the level of the thyroid cartilage. The swelling had a palpable thrill. Examination of the chest revealed normal heart sounds and breath sounds. Introduction His routine blood investigations, chest X-ray, echocar- Retained Foreign bodies in the vascular system are mostly diography were within normal limits. clinical procedure related fragmented devices. Some other An X-ray of the neck showed an opaque foreign body in foreign bodies like fish bone, bone chips, nuts ect. sometimes the right side of his neck (Fig. 1). A doppler ultrasound of penetrate into common carotid artery from upper digestive the neck suggested that there was an AV fistula involving tract. High flying objects like shrapnel, splinters can injure the right common carotid and the internal jugular vein and any blood vessels causing profuse bleeding. But a foreign the foreign body was close to the carotid artery. body in the neck gradually eroding into common carotid Surgical exploration was undertaken under general artery is an extremely rare phenomenon. anaesthesia. Permissive hypercarbia of the level of etco2 at 50-55 mm Hg with hypertension using inotrope with mean BP of 110-120 mm Hg was used. S. Lahiri : S. Ghosh ( * ) The AV fistula was dissected out and after taking RGKar Medical College, Kolkata, India proximal and distal control (Fig. 2), then it was excised. e-mail: drsjghosh@yahoo.co.in Next an attempt was made to localize the foreign body under C-arm guidance. With great difficulty and after G. Sengupta IPGMER & SSKM Hospital, careful palpation of the carotid artery, it was localized to Kolkata, India the undersurface of the carotid artery at the level of the thyroid cartilage. U. Bakshi Palpation also suggested that it was within the vessel. An MGM Medical College & LSK Hospital, arteriotomy was done and the splinter was removed from a Kishungunj, Bihar

Indian J Surg (November – December 2011) 73(6):460 – 462 461 and a tender swelling over the neck. Patient died after 20 days and the post mortem report revealed an injury to the common carotid artery through the lateral wall of pyriform fossa [1]. Few cases of migrating foreign body into the common carotid artery and internal jugular vein from the orodiges- tive tract had been reported in literature [2 – 4]. In such cases high degree of suspicion and imaging of the neck were key points in the diagnosis and surgical removal. Pseudoaneurysms of the internal carotid artery due to trauma have been reported and have a high mortality rate. They generally present with epistaxis, ear bleed or neurodeficits. Pseudoaneurysms of the external carotid artery are very rare [5, 6] and commonly involve the distal portions of its Fig. 1 AP and lateral view X-rays of the neck showing the radio- branches. However, in our case it involved the common opaque foreign body carotid artery. Now a days with increased use of interventional radiolog- saccular aneurysm in the posterior wall of the common ical & cardiological procedures, presence of various materials carotid artery. The aneurysm was repaired and the arterio- like catheter tip guidewire tip, ruptured balloons, embolisation tomy closed with a saphenous vein patch graft. The incision coil [7] etc, are reported in vascular system. However was closed over a drain. penetrating foreign body in arterial tree, particularly in the Postoperative recovery was uneventful and the patient common carotid artery is exceedingly rare [8]. After is doing well, without any neurodeficit or other extensive literature search only one such case had been complication. found to be reported from India in the last ten years, and in that case injury and the foreign body were detected immediately and the repair was done at the same time [8]. Discussion In our patient the injury had occurred two months back and there was minor local bleeding at that time , ‘ Penetrating foreign body causing rupture of the com- which had been repaired. Perhaps the foreign body was mon carotid artery ’ was reported in 1931 by V.E.Negus. lodged initially outside, close to the carotid sheath and This patient had violent cough while eating a cake subsequently due to muscle movement of the neck, containing almond. Subsequently he developed fever eroded through the internal jugular vein into the common carotid artery, producing AV fistula and pseudoaneurysm. Because of the metallic nature of the foreign body, MR angiography was not possible. Doppler ultrasound was done but could not predict the intraluminal position of the foreign body. Exploration of the carotid sheath, palpation of some degree of induration in the common carotid artery and high degree of suspicion of intraluminal position of the foreign body were important steps to the successful operation in this case. This case is rare both, in terms of presentation and in the position of the pseudoaneurysm (with the foreign body lodged in it) involving the common carotid artery. References Fig. 2 Foreign body seen inside the exposed pseudoaneurysm in the 1. Negus VE (1932) Penetrating foreign body causing rupture of the common carotid artery common carotid artery. Proc R Soc Med 25(10):1515

462 Indian J Surg (November – December 2011) 73(6):460 – 462 2. Osinubi OA, Osiname AI, Pal A, Lonsdale RJ, Butcher C (1996) 5. Nadig S, Barnwell S, Wax MK (2008) Pseudoaneurysm of the Foreign body in the throat migrating through common carotid external carotid artery – review of literature. Head Neck 31(1): artery. J Laryngol Otol 110(8):793 – 795 136 – 139 3. Ing Ping Tang, Shashinder Singh, Nair Shoba, Omar Rahmat et al. 6. Campbell AS, Butler AP, Grandas OH (2003) A case of external (2008) Migrating foreign body into the common carotid artery and carotid artery pseudoaneurysm from hyoid bone fracture. Am Surg internal jugular vein – A rare case. In: Auris Nasus Larynx. 69(6):534 – 535 Available via SCIENCE DIRECT. http://www.sciencedirect.com/ 7. Cekirge S, Saatci I, Firat MM, Balkanci F (1995) Retrieval of an science/ Migrating foreign body into the common carotid artery and embolization coil from the internal carotid artery using the amplatz internal jugular vein – A rare case. Accessed 18 November 2008 microsnare retrieval system. Cardiovasc Interv Radiol 18(4):262 – 264 4. Pang KP, Tan G, Chia KH, Tseng GY (2005) Migrating foreign 8. Vijay Thakore, Bhesania RB (1999) Penetrating foreign body in body into the common carotid artery. Otolaryngol Head Neck Surg carotid artery - a case report. Paper #26, 6th, Vascular Society of 132:667 – 668 India Annual Meeting, Hyderbad View publication stats View publication stats