International journal of surgery case reports · 2025
Unusual cause of intestinal obstruction-Gossypiboma mimicking acute appendicitis in a post-hysterectomy patient: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shrestha Samrat, Thapa Kaushal S, Shrestha Mecklina
Аннотация
INTRODUCTION AND IMPORTANCE: Gossypiboma refers to the inadvertent retention of cotton materials, such as gauze, sponges, or towels, inside the body following a surgical procedure. It is most frequently encountered in intra-abdominal or pelvic surgeries, and while preventable, it remains a significant risk.
CLINICAL DISCUSSION: We present a case of a 44-year-old female who underwent total abdominal hysterectomy (TAH) a year ago and presented with right lower abdominal pain, distension, and vomiting. Ultrasonography suggested acute appendicitis and intestinal obstruction, prompting an open appendectomy. During surgery, a retained surgical gauze was discovered 25 cm proximal to the ileocecal junction. The gauze was removed via enterotomy, and the enterotomy was repaired. The patient had an uneventful postoperative recovery.
DISCUSSION: Gossypiboma often occurs in abdominal or pelvic surgeries, with risk factors such as emergency surgeries, high BMI, and excessive bleeding. Literature shows the incidence from 1 in 1000 to 1 in 1500 abdominal operations. It can lead to foreign body reactions like encapsulation, abscess formation, or transmural migration through the intestine. Symptoms can be delayed, and complications may include obstruction or perforation. Diagnosis is challenging but can be aided by imaging like CT scans. Prevention is the key but retained surgical sponges require surgical removal.
CONCLUSION: Gossypiboma, though uncommon, poses a significant risk after abdominal surgeries and can present with vague, nonspecific symptoms, delaying diagnosis. Strict adherence to surgical protocols, including accurate sponge counts and careful intraoperative monitoring, can help prevent the occurrence of retained foreign bodies and their subsequent complications.
CLINICAL DISCUSSION: We present a case of a 44-year-old female who underwent total abdominal hysterectomy (TAH) a year ago and presented with right lower abdominal pain, distension, and vomiting. Ultrasonography suggested acute appendicitis and intestinal obstruction, prompting an open appendectomy. During surgery, a retained surgical gauze was discovered 25 cm proximal to the ileocecal junction. The gauze was removed via enterotomy, and the enterotomy was repaired. The patient had an uneventful postoperative recovery.
DISCUSSION: Gossypiboma often occurs in abdominal or pelvic surgeries, with risk factors such as emergency surgeries, high BMI, and excessive bleeding. Literature shows the incidence from 1 in 1000 to 1 in 1500 abdominal operations. It can lead to foreign body reactions like encapsulation, abscess formation, or transmural migration through the intestine. Symptoms can be delayed, and complications may include obstruction or perforation. Diagnosis is challenging but can be aided by imaging like CT scans. Prevention is the key but retained surgical sponges require surgical removal.
CONCLUSION: Gossypiboma, though uncommon, poses a significant risk after abdominal surgeries and can present with vague, nonspecific symptoms, delaying diagnosis. Strict adherence to surgical protocols, including accurate sponge counts and careful intraoperative monitoring, can help prevent the occurrence of retained foreign bodies and their subsequent complications.