误吞正畸保持器迁移至腰大肌并表现为类神经根症状：一例病例报告

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中文摘要

背景： 尖锐异物（FB）偶尔可穿破胃肠道并迁移至邻近结构，但向后腹膜迁移至腰大肌极为罕见。此类病例可能表现为非典型症状并造成诊断困难。
患者主诉： 一名26岁男性在吞下正畸保持器后出现腹痛。其腹痛好转，但随后出现持续性右下肢感觉异常和酸痛，行走时加重。
诊断： 初次计算机断层扫描（CT）显示一枚金属异物穿透小肠壁。第3天在外院进行的诊断性腹腔镜检查未能找到该异物。第4天复查CT显示异物迁移至右侧腰大肌。6周后再次复查CT显示其向肌肉深部进一步迁移，与其神经系统症状相符。
干预： 同日进行了紧急C臂辅助腹腔镜探查。在游离右半结肠并暴露后腹膜后，通过实时透视定位异物，并将其从腰大肌中完整取出。
结果： 患者神经系统症状在术后立即改善，并在2周随访时完全缓解。术后12个月随访时他完全无症状。
经验教训： 误吞的尖锐异物向腰大肌迁移可无腹膜炎表现而隐匿发生，并可能表现为迟发的类神经根症状。初次探查阴性后症状持续或进展应促使复查CT影像。C臂辅助腹腔镜是取出迁移至后腹膜异物的可行且有效的微创方法。

英文摘要

RATIONALE: Sharp foreign bodies (FBs) can occasionally perforate the gastrointestinal tract and migrate into adjacent structures, but retroperitoneal migration into the psoas muscle is exceedingly rare. Such cases may present with atypical symptoms and pose diagnostic challenges.
PATIENT CONCERNS: A 26-year-old man presented with abdominal pain after swallowing an orthodontic retainer. His abdominal pain improved, but he later developed persistent right lower-limb paresthesia and aching pain that worsened with walking.
DIAGNOSES: Initial computed tomography (CT) demonstrated a metallic FB penetrating a small bowel wall. A diagnostic laparoscopy performed at an outside hospital on day 3 failed to identify the FB. A follow-up CT on day 4 revealed migration of the FB into the right psoas muscle. A repeat CT performed 6 weeks later showed deeper intramuscular migration, correlating with his neurological symptoms.
INTERVENTIONS: A same-day urgent C-arm-assisted laparoscopic exploration was performed. After right colon mobilization and retroperitoneal exposure, the FB was localized using real-time fluoroscopy and completely removed from the psoas muscle.
OUTCOMES: The patient's neurological symptoms improved immediately after surgery, and resolved at the 2-week follow-up. He remained completely asymptomatic at the 12-month postoperative follow-up.
LESSONS: Psoas migration of an ingested sharp FB can occur silently without peritonitis and may present with delayed radiculopathy-like symptoms. Persistent or evolving symptoms after an initial negative exploration should prompt repeat CT imaging. C-arm-assisted laparoscopy is a feasible and effective minimally invasive approach for removing migrated retroperitoneal FBs.