Intestinal Obstruction due to Complete Transmural Migration of a Retained Surgical Sponge into the Intestine

A 56-year-old woman with a history of gynecological surgery for cervical cancer 18 years previously was referred to our hospital for colicky abdominal pain, nausea and vomiting. Intestinal obstruction was diagnosed by contrast-enhanced computed tomography (CT) which showed dilation of the small inte...

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Bibliographic Details
Published in:Case reports in gastroenterology 2012-12, Vol.6 (3), p.754-759
Main Authors: Kato, Takashi, Yamaguchi, Koji, Kinoshita, Koji, Sasaki, Kiyotaka, Kagaya, Hidetoshi, Meguro, Takashi, Morita, Takayuki, Takahashi, Toshiyuki, Tamaki, Nagara, Horita, Shoichi
Format: Article
Language:English
Subjects:
Gossypiboma
Ileus
Intestinal obstruction
Published: December 2012
Retained surgical sponge
Textiloma
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Summary:A 56-year-old woman with a history of gynecological surgery for cervical cancer 18 years previously was referred to our hospital for colicky abdominal pain, nausea and vomiting. Intestinal obstruction was diagnosed by contrast-enhanced computed tomography (CT) which showed dilation of the small intestine and suggested obstruction in the terminal ileum. In addition, CT showed a thick-walled cavitary lesion communicating with the proximal jejunum. 18 F-fluorodeoxyglucose positron emission tomography showed abnormal uptake at the same location as the cavitary lesion revealed by CT. The patient underwent laparotomy for the ileus and resection of the cavitary lesion. At laparotomy, we found a retained surgical sponge in the ileum 60 cm from the ileocecal valve. The cavitary tumor had two fistulae communicating with the proximal jejunum. The tumor was resected en bloc together with the transverse colon, part of the jejunum and the duodenum. Microscopic examination revealed fibrous encapsulation and foreign body giant cell reaction. Since a retained surgical sponge without radiopaque markers is extremely difficult to diagnose, retained surgical sponge should be considered in the differential diagnosis of intestinal obstruction in patients who have undergone previous abdominal surgery.
ISSN:1662-0631
1662-0631
DOI:10.1159/000346285