Presentation and surgical management of a gossypiboma presenting with small bowel obstruction

Abstract

Gossypiboma is a cotton-based foreign body retained within the human body following a surgical procedure. Transmural migration of intra-abdominal gossypiboma into the small bowel is rare; however, it can present with life-threatening complications. We report a case of a 28-year-old male who presented with small bowel obstruction due to gossypiboma, 11 years after the initial surgical procedure. Due to the size of the retained surgical swab, 40 cm × 40 cm, an open surgical approach was preferred. Following removal of the retained swab and bowel reconstruction, the patient was followed in clinic and discharged without complications. Staff education and adherence to operating room record-keeping protocols can prevent gossypiboma. To the best of our knowledge such a long interval between the initial surgery and presentation of gossypiboma that large has not been previously reported in the literature.

Keywords: Case report; Emergency surgery; Gossypiboma; Intestinal obstruction; Transmural migration.

Fig. 1

Axial CT image showing proximal duodenal and gastric distension secondary to heterogenous intraluminal mass at the duodenal jejunal flexure/proximal jejunum which is suspicious for gossypiboma

Fig. 2

Coronal CT image showing proximal duodenal and gastric distension secondary to heterogenous intraluminal mass at the duodenal jejunal flexure/proximal jejunum which is suspicious for gossypiboma

Fig. 3

Intra-operative photograph showing gossypiboma in situ and perforation through the jejunum

Fig. 4

Gossypiboma removed from abdomen, 40 × 40 cm