External Iliac Artery-Appendicular Fistula due to Antegrade Unusual Migration of K-Wire from Hip to Pelvis: An Unreported Complication

Abstract

Background. K-wires are thought to be extremely safe implants and complications as a result of direct insertion or migration are very rare. Complications may be life-threatening in some instances where migration results in injury to vital organs. We report one such case where antegrade migration of K-wire from the hip resulted in injury to external iliac artery and formation of external iliac artery-appendicular fistula. No such complication due to migration has ever been reported in the literature. Case Description. A 15-year-old boy presented with lower abdominal pain, right lower limb swelling and pain, inability to walk, and rectal bleeding for 1 month after 2 K-wires had been inserted in his right hip joint for treatment of slipped capital femoral epiphysis the previous year. On investigation, he was diagnosed to have external iliac artery-appendicular fistula for which he was surgically treated. Clinical Relevance. Antegrade migration of K-wire from hip joint may lead to life-threatening injuries which can be minimized by bending the end of the K-wire, keeping the tip protruding outside the skin wherever possible and by early removal of K-wire once its purpose has been achieved.

Intra-abdominal migration of a k-wire during revision total hip arthroplasty

“…Only a handful of case reports demonstrating this phenomenon exist in the literature, and to our knowledge, none have involved total hip arthroplasty. K-wires have been shown to travel across tissue planes to unintended locations through direct mechanical force (as in our case report) but have also spontaneously migrated to intracardiac and intrathoracic locations through the circulatory system [5]. These events can occur even years after surgical intervention, presenting as culprits for new onset arrhythmias and hemoptysis [6], [7].…”

Intraoperative Kirschner Wire Migration during Robotic Minimally Invasive Spine Surgery

“…K-wires used in fixation of the clavicle have migrated to the soft tissues of the head and neck, the lungs, and even into the spine [10]. When used in hip and pelvic fracture fixations, K-wires have migrated within the pelvis causing soft tissue damage, fistulous tracts between the external iliac artery and the appendix [11], and even long-distance migration to the right ventricle of the heart [12]. To prevent this complication, it is recommended that the wires to be left visible outside the skin when possible, and their ends bent when direct visualization is not possible, and be removed when no longer needed.…”