Transgastric Migration of a Gossypiboma After an Open Cholecystectomy: A Case Report

TL;DR

A surgical sponge was retained in a patient's body after a cholecystectomy and migrated to the stomach, requiring surgical removal.

Contribution

This case report highlights the rare transgastric migration of a gossypiboma after an open cholecystectomy.

Findings

A gossypiboma was found to have eroded the stomach wall and migrated completely into the stomach.

The diagnosis was confirmed using computed tomography (CT) imaging.

The retained surgical sponge was successfully removed via open surgery.

Abstract

Gossypiboma refers to the retention of a surgical sponge or pack in a patient's body, postoperatively, with its occurrence most commonly seen intra-abdominally. It is rare but can lead to serious complications if not treated. It can manifest immediately after surgery or can take several years. Clinical presentation can vary from abdominal symptoms to abscess and sepsis. Its diagnosis can be confirmed via radiological modalities such as computed tomography (CT), plain X-ray, ultrasound, and magnetic resonance imaging, with CT being the gold standard. Once confirmed, it should be removed via open or laparoscopic surgery. We present a case of a 35-year-old patient with no known comorbidities who presented to our surgical department with abdominal pain and vomiting, but was vitally stable. Symptoms were persistent with no response to medications. It was found that she had an open cholecystectomy done five months back. CT confirmed the presence of gossypiboma that had eroded the stomach wall and had completely migrated to the stomach, following which an open surgery was performed, and a Promed pack was retrieved from the stomach.

Gossypiboma is a rarely reported error, but it can be a life-threatening complication of surgery. The most common site of occurrence is the abdominal cavity; other sites include the breast, thorax, and central nervous system. It is most commonly associated with cholecystectomy and is most often found in the subhepatic region; however, it can erode the surrounding viscera and migrate to other organs, as seen in our case. Various radiological modalities such as CT, ultrasound, and magnetic resonance imaging can be used to confirm the diagnosis. As gossypiboma is a serious complication, all measures should be taken to prevent it, as its incidence depends on surgical practices. Proper pack counts, using radio-opaque products, and adherence to standard safety protocols can play a vital role in its prevention. Early diagnosis and treatment can prevent this complication and improve patient outcomes.

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