An unusual cause of small bowel obstruction: Gossypiboma – case report

Abstract

BackgroundThe term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies.Case presentationA 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis.ConclusionsAlthough gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.

Surgical intervention may not always be required in gossypiboma with intraluminal migration

“…Retained sponges are most frequently observed in patients with obesity, during emergency operations [6] and following laparoscopic inter ventions [7] . Gossypiboma is most frequently diagnosed in the intra-abdominal cavity; however, it can also be seen in paraspinal muscles [8] and the intrathoracic region [9] , legs [10] and shoulders [11] .…”

Small Bowel Obstruction and Enterocolic Fistula from a Gossypiboma after Caesarean Section

“…Radiographic imaging to assess possible occurrence of RFB after high-risk operation should be considered, especially when the textile counting seems to be wrongly performed (9,10).…”

Abdominal gossypiboma

“…Инородные тела, непреднамеренно оставленные в брюшной полости во время хирургических вмешательств, -весьма акту-альная проблема в хирургии [7,9], несмотря на немногочислен-ные публикации, посвященные этой теме [1,4,[10][11][12][13][14][15]. По по-нятным причинам мы никогда не узнаем реальное количество таких случаев, особенно, закончившихся благополучно.…”

“…Диагностика за-бытых инородных тел часто оказывается нелегкой задачей, по-скольку выявить отклонения, нетипичные для послеоперацион-ного течения, сложно, особенно в тех случаях, когда речь идет о нерентгеноконтрастных инородных телах, каковыми являются марлевые салфетки [12]. Описаны случаи нахождения инород-ных тел в брюшной полости до 30 лет и более [2,5].…”