Incidental Diagnosis of a Gossypiboma With Complete Transmural Migration Into the Jejunum After a Hysterectomy: A Case Report.

Gossypiboma, or retained surgical sponge, is a rare and preventable surgical complication. Complete transmural migration of a retained sponge into the gastrointestinal tract without overt intestinal perforation is an exceptionally unusual phenomenon that poses significant diagnostic and therapeutic challenges. A 41-year-old woman with a history of open hysterectomy seven months prior presented with progressive neurological deterioration, severe metabolic encephalopathy, and suspected urosepsis, without classical signs of mechanical bowel obstruction. Abdominal computed tomography (CT) demonstrated a pelvic intestinal loop with marked wall thickening and a radiopaque structure preoperatively misidentified as a metallic foreign body within the sigmoid colon. Exploratory laparotomy revealed a dense inflammatory mass involving a matted jejunal loop 60 cm distal to the ligament of Treitz. A 50 cm non-viable jejunal segment was resected, and a double-barrel jejunostomy was performed. Longitudinal opening of the resected specimen revealed a retained surgical sponge completely within the jejunal lumen with spontaneous sealing of the bowel wall. Despite surgical intervention and intensive care support, the patient succumbed to refractory septic shock and multi-organ dysfunction on the first postoperative day. This case illustrates an atypical presentation of a gossypiboma manifesting as chronic systemic inflammation, severe hypoalbuminemia, and metabolic encephalopathy rather than classical bowel obstruction. Documenting this case highlights the diagnostic pitfalls of CT interpretation, where radiopaque markers can mimic metallic foreign bodies or cause anatomical misattribution due to pelvic adhesions, and emphasizes the vital necessity of maintaining a high index of suspicion in any patient with prior abdominal surgery and unexplained systemic decline.