Gossypiboma causing intestinal obstruction

摘要

A 49-year-old male patient presented with short history of pain abdomen, recurrent vomiting and constipation. He had undergone open cholecystectomy for cholelithiasis a year back. Clinical examination revealed mild abdominal distension. Plain abdominal radiograph showed mildly dilated proximal small bowel loops with a linear undulating radio-opaque density in the dilated bowel. Upper gastrointestinal endoscopy showed a foreign body with t+iread like structure in the region of duodenojejunal flexure, suggesting surgical sponge. It could not however be extracted endo-scopically. Contrast enhanced computed tomography (CT) scan of the abdomen (Fig. 1) showed a soft tissue density lesion with mottled lucencies and linear radio-opaque marker in a dilated proximal jejunal loop. There was dilatation of duodenum with abnormal wall thickening of its first and second parts and surrounding fat stranding. The imaging diagnosis was gossypiboma causing intestinal obstruction with first and second parts of duodenum being the possible site of transmural migration of the sponge. The patient underwent laparotomy followed by jejunotomy at approximately 20 cm distal to the duodenojejunal flexure and a large intraluminal gossypiboma measuring 10 x 10 mm in size was retrieved (Fig. 2). Postoperative stay was uneventful and the patient was discharged in stable condition.