Trans-Visceral Migration Of Retained Surgical Gauze As A Cause Of Intestinal Obstruction: A Case Report

Nello Grassi; Calogero Cipolla; Adriana Torcivia; Alessandro Bottino; Eugenio Fiorentino; Leonardo Ficano and Gianni Pantuso

Disclosures

J Med Case Reports 

In This Article

Abstract and Introduction

Introduction: A retained surgical sponge in the abdomen is uncommon although it is likely that this finding is underreported in the medical literature. The intravisceral migration of retained surgical gauze is even rarer, as demonstrated by the very few cases reported.
Case presentation: Three years after undergoing anterior resection of the rectum, a 75-year-old man presented with symptoms of small bowel obstruction. Plain abdominal radiography and CT showed a radio-opaque marker; a foreign body was suspected, probably a piece of retained surgical gauze. An ileotomy of about 5 cm. was performed to confirm this diagnosis and remove the gauze.
Conclusion: Although rare, retained gauze in the abdomen is a complication of surgery. The authors consider that this event may be more frequent than it appears from reports in the literature, probably because of its medico-legal implications. If all such cases were reported, it would be possible to estimate their exact number, classify the occurrence as a possible surgical complication and thus modify its medico-forensic consequences.

Retained surgical gauze in the abdominal cavity is an infrequent event but it may cause symptoms, both in the early postoperative period as well as months or years after the original operation. Non-specific clinical symptoms and inconclusive imaging findings may preclude an accurate diagnosis.[1] It can, however, be diagnosed preoperatively in many instances with the help of radiological studies such as plain radiography, when surgical textile materials have been impregnated with a radio-opaque marker. Ultrasonography (USG), computerized tomography (CT), magnetic resonance imaging (MRI), and gastrointestinal contrast series[2,3] can all be used to assist in diagnosis. A surgical sponge may completely migrate into the intestinal lumen without any apparent opening in the intestinal wall.[4] We report a case of retained surgical gauze causing an intestinal obstruction due to its migration into the small bowel; to the best of our knowledge, there are few similar cases reported in the medical literature.[4,5]

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