A 64 year-old white woman, seamstress, was admitted in a urgent care unit complaining of 24 h of right lower quadrant abdominal pain associated with constipation, anorexia, mild fever, chills and malaise. No significant past medical history was mentioned.
Vital signs assessment revealed normal blood pressure, normal heartbeat frequency with 68 beats/min, non-elevated respiratory rate with 16 breaths/min of respiratory rate and 36  C body temperature. No relevant drug, family, or psychosocial history. Patient's physical examination revealed mild tenderness during palpation of right lower part of the abdomen, however not suggesting clinical peritonitis.
Laboratory results showed Hemoglobin: 14.5 g/dL, Hematocrit: 44.7%, Leukocytes: 11.5 x 103/muL, Platelets: 254 x 103/muL. Amylase, lipase, and liver enzymes were within normal limits.
Plain radiograph revealed a metal density foreign body in the right lower quadrant (see Fig. 1). Computed tomography (CT) showed foreign body within the appendix lumen (see Fig. 2).
A diagnostic laparoscopy was indicated and performed by a gastrointestinal surgeon, after a carefully clinical and imaging analysis. After laparoscopic optical introduction, a vermiform appendix with signs of inflammation related to the needle perforation was observed. An appendicectomy was then performed with carefully maneuvers to avoid injury to adjacent structures (see Fig. 3, Fig. 4, Fig. 5, Fig. 6). Other intestinal segments and intra-abdominal organs did not present any sign of injury. Postoperative period was uneventful and patient was discharged after 2 days. Patient was free of symptoms.
Histopathological analysis of specimen revealed ulcero-flegmonous acute appendicitis, with acute fibrine leukocyte peritonitis.  :