Hammadieh Abdul Rahman, Alsabek Mhd Belal, Rustom Sara
Department of Surgery, Almouwasat University Hospital, Damascus University, Faculty of Medicine, Damascus, Syria.
Department of Surgery, Syrian Private University, Faculty of Medicine, Damascus, Syria.
Ann Med Surg (Lond). 2021 Jan 16;62:283-287. doi: 10.1016/j.amsu.2021.01.016. eCollection 2021 Feb.
Textiloma is a retained surgical item such as a sponge or gauze that is unintentionally left in the surgical field after the wound closure. Here, we present the first reported surgical gauze that penetrated the intestine, made a duodenal-ceca fistula and then stuck far away in the ileum. Mechanical obstruction didn't appear clinically or even in radiological investigations because of the fistula which provided the intestinal continuity.
We report a 34-year-old man with a previous abdominal interventions complained of cramping, frequent vomiting and presence of undigested food in stool. The frequency of the bowel movement increased recently. Endoscopies, radiological investigations and pathological findings figure out a duodenal-ceca fistula with nonspecific inflammatory tissues in the intestinal biopsy. When we performed the abdomen surgery, retained gauze in the ileum was taken out and the duodenal-ceca fistula was fixed.
Gauze or sponge that is forgotten in the surgical field called gossypiboma, textiloma, gauzoma or cottonoid. It could present with various complaints; as an acute or chronic problem, clear or ambiguous symptoms. It could reside in a space; extend across a gap, migrate through a tissue, or even make a fistula between lumina like in our case.
Textiloma could change pre-operative diagnosis, intra-operative techniques, postoperative follow-up plan and prognosis. This is the first report proves its ability to mimic inflammatory diseases that penetrate two different lumina and perform fistula. So it should be written in the list of any differential diagnosis when the patient has a previous procedure or surgery.
纺织瘤是一种残留的手术物品,如海绵或纱布,在伤口缝合后意外留在手术区域。在此,我们报告首例穿透肠道、形成十二指肠-盲肠瘘并随后卡在回肠远处的手术纱布。由于瘘管维持了肠道的连续性,临床上甚至在影像学检查中均未出现机械性梗阻。
我们报告一名34岁男性,既往有腹部手术史,主诉腹部绞痛、频繁呕吐及粪便中有未消化食物。近期排便次数增加。内镜检查、影像学检查及病理结果显示为十二指肠-盲肠瘘,肠道活检有非特异性炎性组织。我们进行腹部手术时,取出了回肠内残留的纱布并修复了十二指肠-盲肠瘘。
手术区域遗留的纱布或海绵被称为棉纤维瘤、纺织瘤、纱布瘤或棉片瘤。它可能表现出各种症状,可为急性或慢性问题,症状明确或不明确。它可能存在于一个腔隙中,跨越间隙,穿过组织迁移,甚至像我们的病例一样在管腔之间形成瘘管。
纺织瘤可改变术前诊断、术中技术、术后随访计划及预后。这是首例证明其能够模拟穿透两个不同管腔并形成瘘管的炎性疾病的报告。因此,当患者既往有手术史时,应将其列入任何鉴别诊断清单中。