Case contributed by Ian Bickle
Diagnosis certain


Young male returns 5 days following left sided urological surgery, with right flank pain and fever.

Patient Data

Age: 31
Gender: Male

Linear high attenuation material in the right with surrounding extra-luminal gas foci, in keeping with an abscess.

Left ureteric stent.

Dilated small bowel, in keeping with bowel obstruction.


Huge gas-fluid filled collection in the right flank, with linear high attenuation material within - in keeping with a central foreign body focus.

The abscess formed around the intraperitoneal foreign body, has resulted in a adhesional small bowel obstruction.


The huge surgical pack retrieved during laparotomy, around which the abscess has formed.

The surgeon was unaware he left it from the primary operation.

Case Discussion

Gossypiboma is a foreign object, such as a mass of cotton matrix (swab, surgical pack) or a sponge, that is left behind in a body cavity during an operation.  By interference it is iatrogenic.

Methods to avoid retention of swap, including 'swab counts' are routine, but clearly do not always work as this case illustrates.  

Significant additional morbidity may follow this error - as in this case when a repeat laparotomy was required not only to remove the foreign body and abscess that developed around it, but also the small bowel obstruction which resulted from its presence.

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