Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy

A case of a stuck mesh in the rectum after pelvic surgery

A 67-year-old woman was referred to our hospital for further evaluation of a positive fecal occult blood test. Colonoscopy revealed an elevated rectal lesion (10 mm in size) with a central depression. A rod-like object was noted in the center of the lesion. Magnifying endoscopy with narrow-band imaging showed obscure surface structures and dilated vessels. Magnifying endoscopy with crystal violet staining showed that the pit pattern had disappeared. These endoscopic findings suggested that the lesion was comprised of granulation tissue. A detailed medical history revealed that she had undergone a total hysterectomy with mesh placement for bladder prolapse. We reasoned that the mesh used during pelvic surgery might have penetrated the rectum. She underwent subsequent surgery to remove the mesh. Although most foreign bodies in the rectum are swallowed or self-inserted, pelvic surgery is another source of foreign bodies in the rectum.

Gossypiboma penetrating into the small intestine similar to Meckel's diverticulum: a report and literature review

Foreign body granuloma due to retained surgical sponge (gossypiboma) with penetration into the small intestine is very rare. Cases of gossypiboma in the abdominal cavity have sometimes been reported, yet the correct incidence has not been determined, only estimated to occur in one of every 1,000 to 1,500 intra-abdominal operations. Acute abdomen may be observed in some cases, requiring treatment. We herein introduce the case of a 70-year-old woman with gossypiboma penetrating into the small intestine presented with anemia and hematochezia. She had a history of emergency laparotomy for ectopic pregnancy several decades ago. A dynamic contrast-enhanced computed tomography revealed a hypovascular mass containing air bubbles that continued to the small intestine approximately 50 mm in size in the right lower abdomen. In addition to describing the presentation and outcome of our patient, we review the image findings of gossypiboma.

A transmural migration of a gossypiboma in the right colon responsible for a mass which mimicked an abscessed colonic tumor: A case report

INTRODUCTION

Gossypiboma or retained surgical sponge is a rare but serious complication of abdominal surgery. Clinical and radiological polymorphism of gossypiboma makes an accurate preoperative diagnosis difficult.

PRESENTATION OF CASE

We report an unusual case of a transmural migration of a gossypiboma in the right colon responsible for a mass which mimicked an abscessed colonic tumor, three years after an open myomectomy. A 40-year-old woman was admitted in emergency with generalized abdominal pain associated with fever. Initially, physical examination revealed an acute localized peritonitis in lower right quadrant. A right pericolic perforated abscess was found. A right hemicolectomy was performed. Surgical specimen dissection revealed an intracolonic surgical sponge.

DISCUSSION

Gossypiboma after laparotomy may present with symptoms of acute surgical or chronic abdominal pain. Radiographs are the most commonly used method to detect retained sponges. Surgery is the preferred method of treatment for gossypiboma.

CONCLUSION

Episodes of atypical colonic obstruction and nonspecific abdominal pain that have occurred for several years in a patient with a history of multiple abdominal surgery should be suggestive of intra-colonic migration of a gossypiboma. The most important approach to reduce the incidence of gossibypomas is prevention.

Anatomical complications of hysterectomy: A review

Hysterectomy is the most commonly performed gynecological procedure in the United States with three possible surgical approaches; vaginal, abdominal and laparoscopic. As with any surgical procedure, various anatomical complications can arise. These include injuries to anatomical structures such as the urinary bladder, ureter, intestines, rectum, anus, and a multitude of nervous structures. Other complications include sexual dysfunction, vaginal cuff dehiscence, and urinary incontinence. Using standard search engines, the anatomical complications of hysterectomies are reviewed. In conclusion, surgeons who perform hysterectomies or are involved with postoperative hysterectomy patients should be familiar with the possible complications of this common procedure and the steps that can be taken to help reduce the risk of those complications. Clinicians should also inform their patients of the potential complications as they can affect lifestyle and comfort. Clin. Anat. 30:946-952, 2017. © 2017 Wiley Periodicals, Inc.