Transmural migration of surgical sponge into the stomach with outlet obstruction: Rare Case
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CASE REPORT
Transmural migration of surgical sponge into the stomach with outlet obstruction: Rare Case Ramender Singh, Rajesh Godara, Surender Verma, Jaspreet Singh, Kaviraj Kaushik, Naveen Verma, Anjali Verma
Abstract Aim: To highlight the unusual postoperative clinical presentation of a retained sponge. Background: Recognition of postoperatively retained foreign bodies is essential but often delayed, either because of medicolegal implications or because of a confusing clinical presentation and non-specific imaging features. In contrast to radio-opaque materials which are detected at follow-up imaging, radiolucent objects like sponges create problems in identification. Case Report: A 30-year-old lady presented with intermittent non-bilious vomiting, epigastric pain and fever. Contrast-
enhanced computed tomography of the abdomen showed a heterogeneous mass in the duodenum with multiple air pockets. Surgical exploration revealed a full-size surgical sponge with one end embedded in the gallbladder fossa and the other perforating the antrum of the stomach, thus causing an obstruction. The sponge was retrieved, and distal gastrectomy with Billroth II anastomosis was performed. The postoperative course was uneventful. Conclusion: A high degree of suspicion and awareness of non-specific symptomatology associated with retained
sponges after surgery is essential for early diagnosis and correct treatment. Key Words: Retained foreign body; medical error
Introduction Surgical cases where instruments or sponges are left behind following a surgical procedure though fortunately uncommon are potentially dangerous medical errors [1]. The literature reports an estimated 1:1,000 to 1:1,500 intraabdominal surgeries result in a retained foreign body. However, the magnitude of the problem is most likely underestimated because of the reluctance on the part of clinicians and hospitals to disclose these types of errors [2]. Furthermore, publishing retained foreign body data are often hampered by the confidentiality requirements of insurance and legal claims [3]. As a result, most studies examining these types of errors to date merely offer descriptions of the frequency and outcomes of the retained foreign body.
Ramender Singh Dept of Surgery and Radiodiagnosis Rajesh Godara, Surender Verma, Jaspreet Singh, Kaviraj Kaushik, Naveen Verma, Anjali Verma Dept of Surgery Post Graduate Institute of Medical Sciences Rohtak, India Correspondent Author: Dr Rajesh Godara Dept of surgery, Post Graduate Institute of Medical Sciences Rohtak, India Tel.: -+919812343765, E-mail: [email protected] Received 29 Nov 2013; Accepted 21 Jan 2014 Hellenic Journal of Surgery 86
Retained foreign body cases are frequently injurious and are associated with a high likelihood of litigation, but they are also avoidable. Gossypibomas result from intra-abdominal retained surgical material with surrounding foreign body reaction [4]. Migration into the stomach, with obstructive symptoms, is a very rare complication [5]. Case Profile
This 30-year-old lady
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