Migration of a foreign body into the colon and its autonomous excretion

Abstract

Background: The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon.

Case reports: The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30 × 65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ulceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity.

Conclusions: Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.

Figure 1

Patient I Abdominal cavity X-ray in the vertical position.

Figure 2

Patient I Abdominal cavity CT scan.

Figure 3

Patient I surgical gauze spontaneously excreted through the colon.