Transmural Migration of Gossypiboma with Intraluminal Small-Bowel Obstruction: A Case Report

A Cotton Rope in the Colon: A Rare Cause of Chronic Abdominal Pain

Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe this condition. We present a case of a 40-cm-long retained surgical sponge in a 43-year-old woman who presented with unexplained chronic abdominal pain for several years. She had a history of open cholecystectomy, hepaticojejunostomy, and enteroenterostomy. Computed tomography scan revealed a large cotton sponge anchored within the large bowel. Surgical exploration is usually required for the retrieval of gossypiboma. However, it was successfully removed endoscopically using a diathermic needle knife with no immediate complications. The patient was discharged after 48 hours with marked improvement in her abdominal pain. This case emphasizes the emerging role of novel endoscopic interventions, resulting in excellent clinical outcomes, avoiding major surgical interventions, and providing cost-effective benefits.

Upper gastrointestinal tract obstruction caused by a gossypiboma: A rare surgical case report

INTRODUCTION

Gossypiboma is a term used to describe a condition of leaving a surgical sponge or any other foreign object in a body cavity after surgery. Gossypiboma is a rare but serious medical and legal problem, as it may cause no symptoms or severe complications in the digestive system. In some cases, Gossypiboma may migrate through the wall of an organ and cause damage, such as perforation, obstruction, or fistula formation.

CASE REPORT

A 46-year-old male presented to the Emergency Department with abdominal pain, diarrhea, vomiting, and weight loss of about 15 kg through 20 days. The condition developed into constipation.

DISCUSSION

The prevalence of complications, known as Gossypibomas, is relatively rare but can cause inflammatory reactions, abscesses, and other complications. Diagnosis is challenging and may require thorough evaluation, imaging, and exploratory surgery. Treatment usually involves surgical removal, either through laparoscopy or laparotomy. Prevention methods, such as accurate counting and implementing surgical safety protocols, are crucial to avoid such incidents.

CONCLUSION

Performing a thorough count of all surgical sponges and instruments at both the start and conclusion of the procedure is the most effective method to prevent Gossypiboma. Other preventive measures include using radiopaque sponges and making sure that all sponges are accounted for before closing the incision.

Unusual journey of migratory foreign bodies in the alimentary tract

Foreign bodies are uncommon, and the migration of ingested or inserted foreign bodies within or out of the gastrointestinal tract is even rarer. Migration of foreign objects from the digestive system to the soft tissue in the neck, genitourinary tract, or abdominal cavity to intraluminal extension in bowel loops is an uncommon but well-reported occurrence. The accidentally retained surgical sponge (gossypiboma) following abdominal or pelvic surgery with transmural migration within the bowel is an extremely rare clinical presentation. The bowel can be penetrated by retained material, which moves within the bowel lumen, resulting in malabsorption, intestinal obstruction, either partial or complete. In a few cases, spontaneous expulsion occurs. The interpretation is done on radiographs in frontal and lateral projections X-rays, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (USG). Computed tomography (CT) is helpful if a radiopaque foreign body is suspected and is the modality of choice. We share with you 2 instances of foreign items migrating outside the digestive tract with a possible history of ingestion and a case of transmural migration of the postcesarean section retained surgical sponge within the alimentary tract, causing bowel obstruction. Diagnosis and the exact location of a foreign body can be established with the judicious use of different modalities. A CT scan is the modality of choice because it provides a road map for surgical intervention.

Gossypiboma left behind in a cesarean section ended up with a failed laparotomic excision, which demanded another laparotomy to remove it: a rare case report

Introduction and importance

Retained surgical items are an uncommon complication for surgical operations, with an estimated incidence of 1 in 5500 to 1 in 18 000 operations. Retained surgical sponges are the most common retained surgical items, accounting for nearly 70%. In 1884, Wilson reported the first retained foreign body after laparotomy.

Case presentation

A 22-year-old woman was referred to our hospital complaining of a feeling of abdominal bloating and heaviness associated with pain, fever, fatigue, and severe stink vaginal discharges. Past surgical history included a cesarean section followed by laparotomy to remove a foreign body left behind; the obstetrician denied the presence of any foreign body. The diagnosis of retained surgical sponges was done in our hospital, according to the clinical history and radiographic study. The second laparotomy was performed, and the surgical sponge was removed.

Clinical discussion

Retained surgical items' symptoms vary according to the site and types of materials. The diagnosis may be difficult because it resembles benign or malignant soft-tissue tumors of the abdomen and pelvis. Ultrasound and computed tomography have been used for the diagnosis of retained surgical items. The minimally invasive surgical approach appears to be most successful if the object is located early in the postoperative course.

Conclusion

Retained surgical items are serious problems of surgical operations and should be among the differential diagnosis of any abdominal pain in patients with a history of prior surgery.