Perforation of small intestine as a rare adverse event of acupuncture: a case report

With the widespread application of acupuncture, there is growing concern about the adverse events (AEs) related to therapy. Acupuncture can result in severe life-threatening AEs in very rare cases, so there are important clinical implications of identifying and reporting the cause of AEs to prevent similar incidents in the future. Herein, we report a rare life-threatening case of small intestine perforation caused by acupuncture. A 71-year-old man was transferred to our emergency department for further treatment due to intestine obstruction with a giant abdominal wall hernia. Before admitting to our hospital, the patient had previously been treated with acupuncture and the acupoints were located on the abdomen and limbs. In view of progressively worsening abdominal pain and intra-abdominal infection, he underwent an emergency exploratory laparotomy. Intraoperative findings confirmed that four perforations of the small intestine were caused by acupuncture. This case report demonstrates that abdominal acupuncture in patients with concurrent intestinal obstruction and a giant abdominal wall hernia carries an extreme risk of iatrogenic bowel perforation, due to the loss of normal anatomical safeguards. Therefore, in this specific high-risk scenario, abdominal needling should be approached with extreme caution or considered contraindicated. Meticulous pre-treatment anatomical assessment is imperative to prevent this life-threatening complication.