Multiple abdominopelvic gossypibomas

Case contributed by Michael P Hartung
Diagnosis certain

Presentation

Abdominal pain and weight loss for 1 year.

Patient Data

Age: 35 years
Gender: Female

Three abdominal collections containing dense, swirling lines: one encapsulated in the right mid abdomen, one encapsulated in the lower right abdomen, and one in the left abdomen eroding into jejunum with mottled air density. Uterus surgically absent with midline scar.

Notice radiodense lines on scout image.

Case Discussion

This was an unexpected case of three abdominal gossypibomas, with the characteristic appearance on imaging with dense, swirling lines. Two are encapsulated and one eroded into the jejunum resulting in a varied appearance (mostly air density). The scout image can be particularly helpful for identifying the radiodense markers that most sponges have, giving confidence to the diagnosis when there is a more complex appearance on the CT images. The oral contrast also contributes to confidence in diagnosing erosion into the small bowel.

The patient's history involved a nearly 1-year history of abdominal pain that began after an emergency total abdominal hysterectomy due to a stillbirth complicated by uterine rupture at an outside facility. Multiple gauze packs were inadvertently left in the patient after surgery, resulting in chronic abdominal pain and eventual erosion of one into the small bowel.

Before surgery, the patient required nutritional optimization for several weeks due to chronic vomiting and severe malnutrition. Surgical resection was then performed and three retained abdominal packs were then retrieved; one adherent to the abdominal wall and covered by the bowel, the second adherent to the omentum, and the third intraluminal in the jejunum requiring resection of the bowel.

Acknowledgement Dr. Moenga Daniel for assistance with this case.

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