Abstract / Summary
Background: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in neurologically impaired children. Although generally safe, inadvertent visceral organ damage during placement may result in rare, catastrophic events like gastrocolic perforation. Subsequent laparoscopic repair introduces further subtle risks, including the retention of broken surgical sharps due to the physical limitations of minimally invasive environments. Finding and extracting these small ferromagnetic components poses a severe technical dilemma, often prolonging anesthesia or forcing conversion to open laparotomy. Magnet-assisted techniques offer a rapid, low-impact rescue alternative. Case Presentation: A 14-year-old boy with severe neurodevelopmental deficits (Dandy–Walker malformation, cerebral palsy, refractory generalized epilepsy) presented with severe peritonitis two weeks following a PEG tube placement. Urgent diagnostic laparoscopy identified multi-site visceral injuries: a through-and-through perforation involving both the anterior and posterior walls of the transverse colon alongside an anterior gastric perforation, secondary to severe colon interposition. While laparoscopically repairing these visceral defects, a 26-mm curved suturing needle fractured inside a 10-mm working trocar, and the sharp tip disappeared into the peritoneal environment. Initial thorough inspection failed to localize the sharp. Postoperative abdominal radiography verified the fragment’s location within the left upper quadrant. During a secondary re-exploration, an improvised magnetic delivery system (comprising small sterile neodymium spheres sealed within a surgical glove finger) was passed through a trocar to rapidly target, capture, and extract the fragment. The subsequent course was complicated by standard adhesive mechanical ileus, requiring further laparoscopic adhesiolysis before successful stabilization.
Conclusion: Concurrent gastrocolic organ perforation and intra-operative instrument fracturing represent a compounding crisis in fragile pediatric cohorts. This case highlights the biomechanical vulnerabilities of minimal-access closures and confirms that an improvised, glove-contained magnetic capture array provides a safe, highly reproducible means to locate and remove retained sharps without open surgery.