Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy

Abstract

Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications.

Keywords: Gossypiboma; Textiloma; Retained foreign object; Surgical sponge; Radiopaque marker

Core tip: This case involved an unusual migration and placement of a retained surgical sponge; the retained sponge penetrated the intestinal submucosa and migrated to the sigmoid colon and rectum, causing formation of a fistula which had two openings. In this case, the importance of the radiopaque marker was reviewed. Surgical materials with radiopaque markers should be used, which make diagnosis significantly in suspected cases of material being left in the abdominal cavity. Without the radiopaque markers, diagnosis of a retained sponge is difficult, as was the situation in this case. We emphasize the importance of using radiopaque-labeled sponges in all abdominal operations and vigilant adherence to surgical material count in all procedures.