An iron deficiency anemia of unknown cause: a case report involving gossypiboma

Gossypiboma mistaken for a hydatid cyst: case report

Although considered a rare complication, gossypiboma continues to be a clinically important and probably more frequently encountered than reported situation. This study aimed to report a case of gossypiboma that was mistaken for a hydatid cyst in the preoperative evaluation. A 34-year-old male patient with a history of Nissen Fundoplication presented with a large mass palpable in the epigastrium and both the left upper and lower quadrants of the abdomen. Computerized tomography was reported to show a 20x18 cm cystic mass with a collapsed germinative membrane inside it. Laparotomy, which was performed with a suggested diagnosis of type 3 hydatid cyst, revealed that the mass was caused by a 30x30 cm surgical abdominal compress. We believe gossypiboma should be kept in mind in the differential diagnosis of abdominal hydatid cysts in the presence of a former abdominal operation, especially when the result of indirect hemagglutination test is negative.

Abdominal Intraluminal Gossypiboma: Demographics, Predictors of Intraluminal Site, Diagnostic and Treatment Measures

Objective

Intra-abdominal gossypiboma may present with variable clinical presentations. The clinical picture that the patient presents with depends on the site of the retained gauze in the abdomen, with transmural migration leading to intraabdominal gauze being a rare occurrence. We systemically analyze articles and reports related to the transmural migration of gossypiboma. In addition, we report a case of ileal transmigration of gossypiboma in a 53-year-old female.

Methods

A systematic literature review was conducted using Embase and Medline for articles pertaining to transmural migration of gossypiboma. Three of the authors extracted the data from the selected studies that relate to the topic. All articles included were in English language and published in peer-reviewed journals. This study was conducted according to the guidelines set out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

A total of 93 cases of intraluminal gossypiboma were found in the literature. The mean age of the patients was 40.4 years and females (77.7%) were affected more than males. The obstetric and gynecologic surgeries were the leading causative operation (41.5%). However, cholecystectomy is the most common single surgery associated with intraluminal gossypiboma. The mean time from the causative operation was 35.16 months. Most patients presented as intestinal obstruction. CT scan was the most sensitive tool to detect any non-specific finding while the endoscopic interventions were the most specific. Ileum is the most common site for intraluminal for migration. Intra-gastric location is related mostly to the hepato-biliary operations. Laparotomy with segmental resection provides a primary treatment and cure.

Conclusion

Clinicians should keep the possibility of gossypiboma, including intraluminal, in their mind when a patient presents with abdominal pain, signs of infection, intestinal obstruction, or a palpable mass any time after abdominal surgery. Measures for prevention and education are the most useful tool to avoid such complications.

Idiopathic weight loss due to an entero-enteric fistula from a gossypiboma retained for 27 years

Gossypiboma refers to a mass formed around surgical instruments or materials left in the body postoperatively. The occurrence of gossypibomas remains an important problem, despite improvements in surgical procedures and operating room facilities. The clinical presentation of gossypiboma can vary depending on the host response. This report describes a case of abdominal gossypiboma after splenectomy. A 48-year-old man who had undergone splenectomy 27 years ago was admitted to our clinic suffering from non-specific symptoms for 2 weeks. He was cachectic, but laboratory test results were normal. Abdominal ultrasonography and computed tomography revealed a mass in the left hypochondrium. An entero-enteric fistula and an encapsulated foreign body (surgical compress) were detected during an exploratory laparotomy, and the foreign body was removed. Preventing gossypibomas is very important because of their potential to create medico-legal problems and increase mortality and morbidity. Therefore, forgotten surgical material should be considered in all patients with a surgical history, and surgery should be performed carefully.

Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review

Background

Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed.

Case presentation

A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.

We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients.

Conclusion

Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

Gossypibomas mimicking a splenic hydatid cyst and ileal tumor : a case report and literature review

BACKGROUND

Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical procedure. Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be a diagnostic dilemma with associated medico-legal implications, and is usually discovered during the first few days after surgery; however, it may remain undetected for many years.

METHODS

We present a gossypiboma case immigrating to small intestine, as well as a literature review of studies published in the English language on intraluminal migration of gossypiboma, accessed through PubMed and Google Scholar databases.

RESULTS

Case of a 51-year-old man who was admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal trauma 8 years previously, and surgery had been performed at another hospital. The physical examination revealed muscular guarding and rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass were suspected based on results of abdominal computed tomography. Therefore, a laparotomy was performed. Segmental ileal resection, end-to-end anastomosis, and splenectomy were performed. The final diagnosis was gossypiboma in both the spleen and ileum. We performed a systemic review of the English-language literature between 2000 and 2010 in PubMed and Google Scholar, and we found 45 cases of transmural migration of surgical sponges following abdominal surgery. Three cases in which the gossypiboma was located in the spleen are also discussed.

CONCLUSION

Gossypiboma should be considered as a differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable mass.