Singhal Pranav Mohan, Vats Manu, Neogi Sushanto, Agarwal Mehul
General Surgery, Maulana Azad Medical College, New Delhi, India.
BMJ Case Rep. 2019 Jun 26;12(6):e228587. doi: 10.1136/bcr-2018-228587.
Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.
棉籽瘤残留是一种罕见且报道不足的手术并发症，其表现形式多样。因此，临床医生需要高度怀疑，才能在术后患者中确诊。一名45岁无症状女性因增强CT提示腹腔内有既往手术残留的异物，前往普通外科门诊就诊。计划择期进行剖腹探查术。术中发现上腹部肠管间有致密粘连。经过细致的粘连松解，发现一个回肠-回肠瘘和一个肠腔内的手术海绵。对受累的回肠段进行了切除和吻合。一名无症状患者出现壁内迁移性棉籽瘤并伴有回肠-回肠瘘的情况极为罕见。在这种情况下，如果没有影像学检查的帮助，外科医生几乎不可能在无症状患者中确诊棉籽瘤。
