Gossypiboma: migration of retained surgical gauze and spontaneous transurethral protrusion

Abstract

behind the urinary bladder. Some irregular hyperdense Case report artefacts were present within both the mass and the bladder (Fig. 2). An exploratory laparotomy disclosed a A 20-year-old woman presented with dysuria and low abdominal pain associated with the spontaneous transurretained surgical gauze with gossypiboma formation, #6 ×6 ×5 cm, in the retrovesical space (Fig. 3). A ethral protrusion of a retained surgical gauze during voiding (Fig. 1). Two years previously she had undergone fistula between the gossypiboma and the bladder resulted in migration of the gauze into the bladder and finally appendectomy and ovarian cyst marsupialization; since then she had experienced frequent episodes of low protrusion from the urethral orifice. The gauze was surgically removed, the bladder repaired and the patient abdominal pain which had been treated as UTIs. A plain radiograph showed a thread-like radio-opacity over the discharged after making an uneventful recovery. pelvis; CT revealed a thick encapsulated cystic mass a b Fig. 2. CT showing the gossypiboma (arrow head) (a) behind and Fig. 1. Gross appearance of the gauze protruding from the urethral orifice.(b) inside the bladder (arrow head). 879

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] .…”

Gossypiboma: Retained Surgical Sponge After Total Abdominal Hysterectomy with Spontaneous Transurethral Partial Extrusion

“…As described by Lin et al, a possible explanation for the present case could be that a gossypiboma formed as a result of chronic inflammation around the retained surgical sponge, which eroded through the posterior wall of the urinary bladder and manifested with urinary symptoms including repeated episodes of urinary tract infections [8]. It is proposed that repeated contractions of the bladder muscle in an attempt to expel the foreign body caused the gossypiboma to extrude through the only exit, the internal urethral meatus and then finally protrude from the external urethral meatus.…”

“…Spontaneous transurethral protrusion is rare, and the present authors have the knowledge of the report of only one case [8].…”

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] . Gossypiboma results in significant morbidity and…”