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Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review.

Lv YX, Yu CC, Tung CF, Wu CC - BMC Surg (2014)

Bottom Line: Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted.Surgical intervention was performed and the gauze was removed successfully.For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect, 4, Taichung, Taiwan. jefferyu@gmail.com.

ABSTRACT

Background: Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed.

Case presentation: A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients.

Conclusion: Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

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Related in: MedlinePlus

The intra-operative finding after removing the gossypiboma. A penetrating ulcer caused by the gossypiboma was noted over anterior wall of the duodenal bulb.
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Figure 5: The intra-operative finding after removing the gossypiboma. A penetrating ulcer caused by the gossypiboma was noted over anterior wall of the duodenal bulb.

Mentions: A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. The pain was mild and non-radiating, without specific relieving or aggravating factors. The patient had no history of nausea, vomiting, general weakness, poor appetite or body weight loss. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Gauze retention in the peritoneal cavity with migration into the duodenum was noted after upper gastrointestinal (UGI) endoscopy (Figure 1). An abdominal X-ray examination showed the retained material was a surgical sponge (Figure 2). Abdominal computed tomography (CT) scan showed transmural migration of the gauze into the duodenum (Figure 3). Endoscopic intervention failed to remove the entire gauze, and intractable duodenal ulcer caused by the gauze persisted. Surgical intervention was then performed. During the operation, a gossypiboma, about 2 cm in size, was noted between the supra-duodenal region and round ligament (Figure 4), with penetration into the anterior wall of the duodenal bulb, resulting in a penetrated duodenal ulcer about 1.5 cm in diameter (Figure 5). The gauze was embedded in the granulation tissue surrounding the gossypiboma (Figure 6). The gauze was removed successfully, and the penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.


Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review.

Lv YX, Yu CC, Tung CF, Wu CC - BMC Surg (2014)

The intra-operative finding after removing the gossypiboma. A penetrating ulcer caused by the gossypiboma was noted over anterior wall of the duodenal bulb.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4061322&req=5

Figure 5: The intra-operative finding after removing the gossypiboma. A penetrating ulcer caused by the gossypiboma was noted over anterior wall of the duodenal bulb.
Mentions: A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. The pain was mild and non-radiating, without specific relieving or aggravating factors. The patient had no history of nausea, vomiting, general weakness, poor appetite or body weight loss. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Gauze retention in the peritoneal cavity with migration into the duodenum was noted after upper gastrointestinal (UGI) endoscopy (Figure 1). An abdominal X-ray examination showed the retained material was a surgical sponge (Figure 2). Abdominal computed tomography (CT) scan showed transmural migration of the gauze into the duodenum (Figure 3). Endoscopic intervention failed to remove the entire gauze, and intractable duodenal ulcer caused by the gauze persisted. Surgical intervention was then performed. During the operation, a gossypiboma, about 2 cm in size, was noted between the supra-duodenal region and round ligament (Figure 4), with penetration into the anterior wall of the duodenal bulb, resulting in a penetrated duodenal ulcer about 1.5 cm in diameter (Figure 5). The gauze was embedded in the granulation tissue surrounding the gossypiboma (Figure 6). The gauze was removed successfully, and the penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.

Bottom Line: Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted.Surgical intervention was performed and the gauze was removed successfully.For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect, 4, Taichung, Taiwan. jefferyu@gmail.com.

ABSTRACT

Background: Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed.

Case presentation: A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients.

Conclusion: Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

Show MeSH
Related in: MedlinePlus