Intraperitoneal migration of a hookwire following wide local excision of a breast lesion presenting as a spontaneous pneumothorax

Hookwire migration is a rare complication of wide local excision surgery for breast neoplasia. We report the case of a 64-year-old woman who presented to hospital with acute on chronic left upper quadrant and left scapular pain. She had undergone a hookwire-guided wide local excision of a right breast neoplasm 5 years previously. Her vital signs, clinical examination and blood test were unremarkable. A CT scan revealed a left-sided pneumothorax and a 20 cm metallic intraperitoneal foreign body transpiercing the diaphragm. A review of the patient’s clinical record revealed that she experienced a vagal collapse during hookwire implantation. This article underlines the importance of clear communication between members of a multidisciplinary team involved in a staged surgical intervention and exemplifies that foreign bodies can migrate across large distances, sometimes against gravity, to cross multiple anatomical compartments and cause iatrogenic injuries multiple years after an index intervention