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Case Reports
. 2021 Sep 9;13(9):e17846.
doi: 10.7759/cureus.17846. eCollection 2021 Sep.

Gossypiboma Complicating as Colouterine Fistula in a Young Woman Post-Cesarean Section

Pratik K Jha  1 , Awgesh Verma  1 , Mumtaz A Ansari  1 , Vivek Srivastava  1
Affiliations
Case Reports

Gossypiboma Complicating as Colouterine Fistula in a Young Woman Post-Cesarean Section

Pratik K Jha et al. Cureus. .

Abstract

Gossypiboma is a mass of foreign body with cotton matrix accidentally left inside the body after a surgical procedure. It is a surgeon's nightmare and has a varied presentation ranging from asymptomatic cases to the formation of an abscess, mass, intestinal obstruction/perforation, malabsorption, gastrointestinal hemorrhage, and various internal and external fistulization. Genital tract fistulas are one of the most distressing conditions for women of reproductive age that not only hamper their day-to-day work but also impair their social life and psychological state. Colouterine fistula is a rare pathology and has been mainly reported as a complication of diverticulitis in the elderly. We present here a case of gossypiboma presenting as colouterine fistula in a young lady following lower segment cesarean section. The case highlights a rare complication of gossypiboma, probably the first of its kind, and the diagnostic challenges that it presents.

Keywords: colo-uterine fistula; diverticulitis; gossypiboma; lower segment caesarean section; obstruction; perforation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Ultrasonography and magnetic resonance imaging with fistulography
(a) Ultrasound of abdomen showing a bulky uterus with intraluminal air foci (left arrow) and a hyperechoic mass with posterior acoustic shadowing in left parauterine space (right arrow). (b) MRI lower abdomen with fistulogram showing intraluminal air foci in the uterus, and (c) a fistulous tract between endometrial cavity (left arrow) and adjacent sigmoid colon (right arrow) in the left cornu region. (d) A mass with whorled stripes (arrow) in a fluid-filled cavity with low signal in the peripheral wall on axial TSE-T2 weighted image suggestive of gossypiboma.
Figure 2
Figure 2. Intraoperative finding
Encountered surgical sponge after exploration and meticulous adhesiolysis
Figure 3
Figure 3. Intraoperative anatomy after removal of gossypiboma
Site of gossypiboma with colo-uterine fistula. Note the adjacent openings on the medial aspect of the adhered sigmoid colon and the left cornu of the uterus.
Figure 4
Figure 4. Retrieved foreign body and gross pathological specimen
(a) Retrieved specimen of retained surgical sponge (gossypiboma), (b) without radiopaque thread, (c) gross specimen of resected colouterine fistula
See this image and copyright information in PMC

References

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