Postoperative Adhesive Intestinal Obstruction from Gossypiboma
A 41-year-old multiparous lady presented with abdominal pain and vomiting for 3 days and constipation for 2 days. There was history of abdominal hysterectomy 2 months before. All vital signs were normal. A per-abdomen examination revealed distension. All routine investigations were within normal limits. Radiology was inconclusive as the skiagram showed a vague radio-opaque shadow anteriorly. Exploratory laparotomy revealed dense adhesions between the bowel loops. A piece of gauze surrounded by omentum was removed. Grossly, we received omentum densely adherent to gauze piece measuring 10 cm × 8 cm × 2 cm. Microscopically, the sections from omentum revealed extensive granulomatous inflammation with numerous multinucleated foreign body type of giant cells, fibrosis, and chronic inflammatory cell infiltrate comprising lymphocytes, few plasma cells, eosinophils, and macrophages. In the central portion, the whorled stripes of gauze fibers were also seen. Postoperative course was uneventful [Figures –].