Post Caesarean section 8 months ago.
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A well-defined rounded sponge-like hypodense lesion is seen in the left iliac fossa region simulating fecal matter. The lesion is surrounded by soft tissue thickening, marked inflammatory reaction and air density foci between lesion and anterior abdominal wall denoting viscus perforation. After contrast enema the lesion is seen inside proximal sigmoid colon and contrast surrounds portion of the lesion.
Sponge-like hypodense lesion simulating fecal matter outside the bowel with surrounding soft tissue thickening and inflammatory reactions in a postoperative patient denoting retained surgical gauze (missed towel).
When the lesion seen inside bowel, the diagnosis of missed towel become difficult as the lesion simulate fecal matter inside bowel, but the presence of air foci outside bowel and surrounding inflammatory reactions suggesting perforated viscus. This makes the diagnosis of a missed towel eroding the bowel wall more probable.
In this case postoperative data confirmed the diagnosis of missed towel eroding the wall of sigmoid colon.