Gossypiboma

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis certain

Presentation

The patient gave a history of a previous cholecystectomy 35 days ago presented by upper abdominal pain ,fever and infected wound with pus discharging, ultrasound was done that revealed heterogenous echogenic structure along the operative bed with acoustic shadowing and surrounding reaction raising suspicion of a true pathology, so prompted to do X-ray and CT imaging.

Patient Data

Age: 40 years
Gender: Male
x-ray

Dense linear shaped conglomerated metallic structure is seen along the right para-umbilical level suggesting for a foreign body.

ct

CT images (AX, COR) revealed a low-density heterogeneous spongiform mass containing central gas bubbles with an external thickened heterogenous wall (enveloping dense linear metallic marker) with surrounding reactive changes along the cholecystectomy operative bed abutting anterior abdominal wall anteriorly and surgical sutures.

Note the thin metallic structure seen in the wall of the mass and in a 3D perspective on volume rendering.

Case Discussion

The patient underwent surgical exploration that revealed missed towel (gossypiboma) that eventually removed.

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