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

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Pectus excavatum repair often involves substernal bar placement.
• The Highly Modified Ravitch Repair (HMRR) is a surgical technique for pectus excavatum.
• Bar removal is typically a straightforward procedure.

Observation:

• A 20-year-old male experienced complications during attempted Ravitch bar removal 29 months post-HMRR.
• Chest X-ray suggested adequate bar placement, but computed tomography (CT) was inconclusive regarding diaphragmatic position.
• The bar was found to have migrated intra-abdominally to the liver's bare area.

Findings:

• Video-assisted thoracoscopic surgery (VATS) successfully retrieved the migrated pectus bar.
• No diaphragmatic defect or hernia was identified despite the bar's intra-abdominal migration.
• Intra-abdominal migration of a pectus bar is an uncommon clinical event.

Implications:

• VATS is an effective and safe method for removing migrated pectus bars.
• This case highlights the potential for rare complications following pectus excavatum repair.
• Accurate diagnosis and minimally invasive techniques are crucial for managing such rare surgical issues.