<p>Abdominal Intraluminal Gossypiboma: Demographics, Predictors of Intraluminal Site, Diagnostic and Treatment Measures</p>

Abstract

Objective: Intra-abdominal gossypiboma may present with variable clinical presentations. The clinical picture that the patient presents with depends on the site of the retained gauze in the abdomen, with transmural migration leading to intraabdominal gauze being a rare occurrence. We systemically analyze articles and reports related to the transmural migration of gossypiboma. In addition, we report a case of ileal transmigration of gossypiboma in a 53year-old female. Methods: A systematic literature review was conducted using Embase and Medline for articles pertaining to transmural migration of gossypiboma. Three of the authors extracted the data from the selected studies that relate to the topic. All articles included were in English language and published in peer-reviewed journals. This study was conducted according to the guidelines set out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 93 cases of intraluminal gossypiboma were found in the literature. The mean age of the patients was 40.4 years and females (77.7%) were affected more than males. The obstetric and gynecologic surgeries were the leading causative operation (41.5%). However, cholecystectomy is the most common single surgery associated with intraluminal gossypiboma. The mean time from the causative operation was 35.16 months. Most patients presented as intestinal obstruction. CT scan was the most sensitive tool to detect any nonspecific finding while the endoscopic interventions were the most specific. Ileum is the most common site for intraluminal for migration. Intra-gastric location is related mostly to the hepato-biliary operations. Laparotomy with segmental resection provides a primary treatment and cure. Conclusion: Clinicians should keep the possibility of gossypiboma, including intraluminal, in their mind when a patient presents with abdominal pain, signs of infection, intestinal obstruction, or a palpable mass any time after abdominal surgery. Measures for prevention and education are the most useful tool to avoid such complications.

Successful Endoscopic Removal of a Transmural Internally Migrating Gossypiboma

“…Open or laparoscopic surgical removal is the preferred approach depending on the size and location of the gossypiboma and the skills of the surgeon. 5 In cases with intraluminal migration of the gossypiboma, with no evidence of free perforation or bleeding, complete endoscopic approach can also be attempted for the removal of gossypiboma as was successfully done in the present case. 4 To conclude, gossypiboma is a rare and serious adverse event and mostly requires surgery.…”

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

“…CT is highly sensitive and specific in identifying gossypiboma, whereas magnetic resonance imaging has a reported sensitivity of around 100%. 12,13 Surgery is the conventional method for retrieval when there is evidence of adhesion and/or partial displacement, whereas the utilization of minimally invasive approaches such as endoscopy may be feasible depending on the gossypiboma location and the availability of expertise. When there is transmural migration of gossypiboma in the digestive tract without evidence of perforation or obstruction, endoscopy might serve as a viable option for their extraction.…”

“…CT is highly sensitive and specific in identifying gossypiboma, whereas magnetic resonance imaging has a reported sensitivity of around 100%. 12 , 13 …”

Endoscopic Removal of a Transgastric Migrated Textiloma: A Case Report

“…The clinical presentation is unspecific depending on the exact site where the retained gauze is located [ 7 ]. It can remain asymptomatic.…”

“…Bowel obstruction can also complicate gossypiboma. It can concern either the small intestine [ 4 , 7 , 9 ] or the colon [ 8 ].…”