Emergency Presentation of Abdominal Pain with Unusual Etiology

  • Abdul Naeem
  • Maria Aziz
  • Alia Mir
  • Hamid Sial
  • Muhammad Mudassir Shafiq
  • Iram Arshad
Keywords: Gossybioma, Abdominal pain, Laparotomy.

Abstract

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit.

References

1. Wahadni A, Hamad K, Tarawneh A. Foreign Body Ingestion and Aspiration in Dentistry: A Review of the Literature and Reports of Three Cases. Dental Update: Dec 2006,33(9):561-2,564-6, 569-70. DOI: 10.12968/denu.2006.33.9.561
2. Carolina A. Intentional Ingestion and Insertion of Foreign Objects: A Forensic Perspective. J Am Acad Psychiatry Law 40:119 –26, 2012
3. Luciano A, Fustinoni O. Neurologic Aspects of Systemic Disease Part III, Handbook of Clinical Neurology, 2014
4. Ali Kamali A, Moudi E. Abdominal foreign body with unusual presentation. Caspian J Intern Med 2017; 8(2):126-128
5. Kim HS, Chung TS, Suh SH, Kim SY. "MR imaging findings of paravertebral gossypiboma". AJNR 2007, Am J Neuroradiol 28 (4):709–713.
6. Agrawal N, Sodhi M, Malik N. Gossypiboma: A Rare Case Report. Int J Oral Health Med Res 2016;2(6):75-78.
7. F Kiernan, M Joyce, C K Byrnes, H O'Grady, F B V Keane, P Neary. Gossypiboma: a case report and review of the literature. Ir J Med Sci. 2008 Dec;177(4):389-91.
8. Yildirim S, Tarim A, Nursal TZ, Yildirim T, Caliskan K. Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg. 2006 Aug; 391(4):390-5.
9. Wattanasirichaigoon S. Transmural migration of a retained surgical sponge into the intestinal lumen: an experimental study. J Med Assoc Thai. 1996 Jul; 79(7):415-22.
10. T Patial, V Thakur, NK Vijhay Ganesun, M Sharma. Gossypibomas in India - A systematic literature review. J Postgrad Med. 2017 Jan-Mar; 63(1): 36–41.
11. Hyslop JW, Maull KI. Natural history of the retained surgical sponge. South Med J. 1982 Jun; 75(6):657-60.
12. Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY. Report of gossypiboma from the standpoint in medicine and law. World J Gastroenterol. 2005 Feb 28; 11(8):1248-9.
13. Zantvoord Y, van der Weiden RM, van Hooff MH. Transmural migration of retained surgical sponges: a systematic review. Obstet Gynecol Surv. 2008 Jul; 63(7):465-71.
14. Koornstra JJ, Weersma RK. Management of rectal foreign bodies: description of a new technique and clinical practice guidelines. World J Gastroenterol 2008; 14: 4403-6.
15. Srivastava KN, Agarwal A. Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature. Case Rep Surg. 2014;2014:713428.
16. Rajiv J, Mohan G. A study of abdominal gossypiboma. JMEDS. 2016;44:2825–30.
17. Edward F, Fleischmann D. CT artifacts: Causes and reduction techniques. Imaging Med. (2012) 4(2), 229-240
18. Kabba, M.S., Forde, M.Y., Beckley, K.S. et al. Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report. BMC Surg 20, 242 (2020). DOI: https://doi.org/10.1186/s12893-020-00904-7
19. Manzella A, Filho PB, Albuquerque E, et al. Imaging of gossypibomas: pictorial review. Am J Roentgenol. 2009;193:94–101.
20. Sozutek A, Karabuga T, Bozdag AD, et al. Asymptomatic gossypiboma mimicking a liver mass. Turk J Surg. 2010;26:225–8.
21. Sozutek A, Yormaz S, Kupeli H, et al. Transgastric migration of gossypiboma remedied with endoscopic removal: a case report. BMC Res Notes. 2013;6:413.
22. Kiernan F, Joyce M, Byrnes CK, et al. Gossypiboma: a case report and review of the literature. Ir J Med Sci 2008; 177: 389-91.
23. Ryan G, Kawka M, Gnananandan J, Yip V. Presentation and surgical management of a gossypiboma presenting with small bowel obstruction. Clinical Journal of Gastroenterology (2021) 14:1067–1070.
24. Memon A, Khan N, Samo K, Bhatti A, Kumar R, Nouman M. Assigning Responsibility for Gossypiboma (Abdominal Retained Surgical Sponges) in Operating Room. Journal of the Dow University of Health Sciences Karachi 2012, Vol. 6 (3): 106-109.
25. Rizwan F, Swaleh A, Ahmed F, Iqbal Z, Ahmed R. GASTRIC GOSSYPIBOMA. PJR January - March 2011; 21(1): 37-39.
Published
2022-06-30
How to Cite
1.
Naeem A, Aziz M, Mir A, Sial H, Shafiq M, Arshad I. Emergency Presentation of Abdominal Pain with Unusual Etiology. JRMC [Internet]. 30Jun.2022 [cited 12Aug.2022];26(2):333-6. Available from: https://journalrmc.com/index.php/JRMC/article/view/1832
Section
Case Reports