Intra-abdominal pectus bar migration – a rare clinical entity: case report

Abstract

We present the case of a 20-year-old male who underwent successful surgical correction of pectus excavatum with the Highly Modified Ravitch Repair (HMRR). At 29 months the attempted operative removal of the Ravitch bar was unsuccessful despite the impression of adequate bar location on chest x-ray. Subsequent imaging with computed tomography was unclear in determining whether the bar was supra or infra-diaphragmatic due to the tissue distortion subsequent to initial surgery. Video assisted thoracoscopic surgery (VATS) successfully retrieved the bar and revealed that it was not in the thorax, but had migrated to the intra-abdominal bare area of the liver, with no evidence of associated diaphragmatic defect or hernia. Intra-abdominal pectus bar migration is a rare clinical entity, and safe removal can be facilitated by the use of the VATS technique.

Devastating Complications of Metal Strut Migration Following Pectus Excavatum Repair

“…In our case, the strut migration into the heart followed the removal of a dislocated metal strut less than 6 months after the PE repair which is one of the earliest found in the literature (6 months to 37 years). 6 8 There are no valid comparisons of the modified Ravitch technique strut migrations versus the Nuss bar migrations. The exact mechanism of this painless heart perforation is not known.…”

“…The metal strut displacement after the modified Ravitch procedure is extremely rare and can have intrathoracic or intraabdominal propagation. 2 3 4 5 6 7 There are less than 20 reports in the literature of patients whose postoperative course had been complicated by migration of the metal strut into the pericardium, right atrium, left and right ventricle, the abdomen, and left upper bronchus. 8 Our patient had been operated with two stainless steel 30 cm struts with end perforations; the technique being chosen due to the severity and asymmetry of the pectus excavatum (PE).…”

Fate of allogenic bone graft for sternal support in pectus excavatum repair

“…The main disadvantages of these implants are excessive rigidity with the risk of erosion of adjacent vital structures, leading to potentially catastrophic injuries, risks of infection and migration, insufficient strength, immunologic reactions, and the impossibility of incorporation into the host tissue. 2–6,7,11 Furthermore, the majority of these implants need to be removed after a period of 6 months to 2 years in a second operation which was found to involve a complication rate of 2.6% in a series of 1262 patients reported by Saxena and colleagues. 12 Luzzi and colleagues 13 advocated the use of bioabsorbable mesh for sternal support.…”

“…The use of a sternal support in the form of metallic, synthetic, and biological materials is reassuring for correction of the deformity, with a low incidence of recurrence. In this regard, there have been inherent complications reported with various implants used for sternal support, such as migration, 2 perforation of adjacent vital organs with a fatal outcome, 3–6 and pain, infection, or allergic reactions to metal. 7 Moreover, these implants have to stay in place for one to two years.…”

Development of a computer-aided design and finite-element analysis combined method for customized Nuss bar in pectus excavatum surgery

“…3 . This procedure involves inserting a convex Nuss bar under the sternum through small bilateral thoracic incisions without incising the anterior chest wall 4 . Because of small skin incisions, shorter preoperative, intraoperative and post-operative time, and minimal blood loss, this method is accepted by an increasing number of patients with pectus excavatum 5–7 .…”