Lv Yun-Xiao, Yu Cheng-Chan, Tung Chun-Fang, Wu Cheng-Chung
Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect, 4, Taichung, Taiwan.
BMC Surg. 2014 Jun 10;14:36. doi: 10.1186/1471-2482-14-36.
Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed.
A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients.
Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.
棉籽瘤是一个术语，用于描述手术过程中意外遗留在患者体内的棉海绵或腹部敷料周围形成的肿块。据报道，腹腔内棉籽瘤可经消化道、膀胱、阴道和膈肌发生透壁迁移。开放手术是治疗棉籽瘤最常用的方法。然而，当棉籽瘤迁移至消化道时，可通过内镜将其取出。我们报告一例因棉籽瘤透壁迁移导致的顽固性十二指肠溃疡，经十二指肠修补术成功治疗。并提供了系统的文献综述，提出了治疗方法的方案。
一名61岁的汉族男性，在过去10个月中出现间歇性上腹部疼痛。10个月前，他在另一家医院因急性坏疽性胆囊炎接受了腹腔镜胆囊切除术转为开放胆囊切除术。发现棉籽瘤透壁迁移至十二指肠。内镜干预未能取出整块纱布，纱布导致的十二指肠溃疡持续存在。进行了手术干预，成功取出了纱布。穿透性溃疡用十二指肠修补术修复。术后恢复顺利。我们系统地回顾了关于棉籽瘤透壁迁移至十二指肠的文献，并概述了已发表的病例。我们在PubMed上的搜索产生了7篇关于保留手术海绵透壁迁移至十二指肠的报告。两名患者需要手术干预。
棉籽瘤透壁迁移至十二指肠是一种罕见的手术并发症。治疗策略包括内镜取出和手术干预。对于活动性出血、胃肠道梗阻或腹腔内感染等紧急情况，应考虑及时进行手术干预。对于非紧急情况，对于内镜取出失败的顽固性病例，可考虑手术干预。
