A novel laparoscopic magnet-assisted technique for extracting a retained needle after repair of PEG-related gastrocolic perforation in a neurologically impaired adolescent: a case report

Background Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in neurologically impaired children. Although generally safe, PEG placement may rarely result in major complications such as visceral perforation or retained surgical items. Loss of a laparoscopic needle is an uncommon but potentially serious event due to its risk of migration and the technical challenge of retrieval. Case Presentation: A 14-year-old boy with Dandy–Walker malformation, cerebral palsy, refractory epilepsy, and dysphagia underwent PEG insertion. Two weeks later, he presented with peritonitis. Emergency laparoscopy revealed a perforation of the transverse colon and additional posterior colonic and anterior gastric perforations secondary to gastrocolic interposition during PEG placement. All defects were repaired laparoscopically. During extraction of the suturing needle through a trocar, the needle fractured and was lost within the peritoneal cavity. Postoperative radiography confirmed the retained metallic fragment. A second laparoscopy successfully retrieved the needle using a simple magnet-assisted technique in which small sterile magnets were enclosed in a glove finger and introduced through a trocar. The postoperative course was complicated by mechanical ileus requiring further laparoscopic interventions. Conclusion This case illustrates two rare but significant complications after PEG placement—gastrocolic perforation and intra-abdominal loss of a laparoscopic needle—and demonstrates a practical magnet-assisted method for retrieval. Strict adherence to instrument-count protocols and early imaging when needle loss is suspected are essential to reducing morbidity in this vulnerable patient population.