Transmural penetration of sigmoid colon and rectum by retained surgical gauze after hysterectomy

초록

Reports of retained surgical gauze, or gossypiboma, are not frequent. Due to its relative rarity and medicolegal implications, it is difficult to be informed whether there has been an occurrence. Although several cases of complete migration of surgical gauze into the colon have been reported, to our knowledge, following case seems to be the first reported case of gossypiboma caused by transmural penetration of colon by retained surgical gauze. This case has been referred from an overseas institution. A 39-year-old Uzbekistan female presented complaints of vague lower abdominal pain, fever, and purulent rectal discharge for a month. She had undergone open hysterectomy in Uzbekistan approximately fifteen months prior to this visit. The colonoscopy revealed that retained surgical gauze had penetrated the sigmoid colon and rectum. Generally, retained surgical gauze can easily be recognized on plain abdominal radiographs or computed tomography. The radiopaque marker in the gauze serves as an indicator. However, in this case, the abdominal plain X-ray showed no remarkable findings and abdominal computed tomography displayed only the bowel wall thickening in the rectosigmoid area with pericolic inflammatory change. This was due to the fact that the gauze used in Uzbekistan was not labeled with radiopaque marker. Because of the severe local inflammatory process related to the entrance site of the retained gauze, the patient underwent a low anterior resection. Here, we report an extremely rare case in which retained surgical gauze eroded into the sigmoid colon and rectal wall and finally penetrated it (Fig. 1, 2), inducing lower abdominal pain and purulent rectal discharge after hysterectomy.