Gossypiboma Complicating Conservative Treatment of Post-Operative Fistula and a Proposed Classification System

Abstract

Introduction: Gossypiboma denotes surgically retained cotton or sponge following intra-abdominal procedures. The incidence of gossypiboma as a cause of small bowel obstruction still remains very low, probably due to under reporting. Presentation of Case: A case report of a 45 yr old female with mechanical small bowel obstruction from gossypiboma. She had exploratory laparotomy with extraction of three pieces of rolled up gauzes. Discussion: The theory for intraluminal gossypiboma is the suppurative inflammation and necrosis with transmigration of the retained intra-abdominal gauze through a spontaneous enteric fistulation. We propose a possible alternative theory; the migration of sponge into bowel lumen through an iatrogenic fistulous tract following conservative treatment of enterocutaneous fistula and a possible classification of gossypiboma into (intra-operative and post-operative) base on timing of occurrence. Conclusion: In recognition of post-operative gossypiboma, management of enterocutaneous fistulas should be considered an extended continuation of intra-abdominal procedures.