Ishii Takehiro, Matsumoto Satohiro, Miyatani Hiroyuki, Mashima Hirosato
Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
Clin J Gastroenterol. 2019 Jun;12(3):254-257. doi: 10.1007/s12328-018-0920-y. Epub 2018 Nov 19.
Gossypiboma is an iatrogenic granuloma caused by retained surgical gauze. A 48-year-old woman with a history of cesarean section was incidentally found to have a pelvic mass on preoperative computed tomography examination for pectus excavatum. Abdominal enhanced computed tomography showed a 40-mm mass containing air in the pelvis. The mass was suspected to be continuous with the ileum. Transanal double-balloon enteroscopy showed a small fistula that was likely caused by penetration of the ileum dozens of centimeters from the ileocecal valve. A yellow-brown, movable, and fibrous body was found in the fistula. A part of the fibrous body was extracted with forceps. Pathological examination revealed that it was gauze. This is the first reported case of an asymptomatic gossypiboma penetrating the ileum that was diagnosed with double-balloon enteroscopy. Our results suggest that double-balloon enteroscopy is useful for early diagnosis of pelvic mass penetrating intestine, including gossypiboma.
棉籽瘤是一种由残留手术纱布引起的医源性肉芽肿。一名有剖宫产史的48岁女性，在因漏斗胸进行术前计算机断层扫描检查时偶然发现盆腔有肿物。腹部增强计算机断层扫描显示盆腔有一个40毫米的含气肿物。该肿物疑似与回肠相连。经肛门双气囊小肠镜检查发现一个小瘘管，可能是回肠距回盲瓣数十厘米处穿孔所致。在瘘管中发现一个黄褐色、可移动的纤维状物体。用镊子取出了部分纤维状物体。病理检查显示为纱布。这是首例经双气囊小肠镜诊断的无症状棉籽瘤穿透回肠的病例。我们的结果表明，双气囊小肠镜对于早期诊断包括棉籽瘤在内的盆腔肿物穿透肠道很有用。
