Retained intra-abdominal surgical sponge causing ileocolic fistula diagnosed by colonoscopy.

INTRODUCTION

Retained surgical sponges and instruments is a well-recognized medical error that may occur after all kinds of surgeries. This event has a catastrophic impact on the patient, health care workers, and the health institution. Sometimes, it is termed as textiloma or gossypiboma.

CASE PRESENTATION: A 40-year-old lady presented with abdominal pain, diarrhea and bilious vomiting for 3 days. The patients had history of cesarean section which was performed before 4 months. During examination she was pale and she had tenderness in the lower abdomen. CT-scan of the abdomen showed thickening of the wall of the sigmoid colon with evidence of intramural air and dilated small bowel loops. Colonoscopy showed evidence of surgical sponge causing transmural erosion and ulceration of the sigmoid colon. During surgery there was an evidence of a retained surgical sponge resulting in fistula between the ileum and the sigmoid colon. Resection of the involved part of the ileum and the sigmoid colon was done with end-end anastomosis. After 10 days she developed complete abdominal dehiscence. An emergency operation was performed for the patient and the abdomen was closed with tension sutures.

CONCLUSION

The surgical team is responsible for preventing this event by careful inspection of the surgical site using all the available methods and technology. Technology increases the safety but doesn't accurately prevent the accidents. All causative human and technical factors must be addressed carefully.