Gossypiboma, Varied Presentations: A Report of Two Cases
A 35-year-old female presented with a 15-day history of pus discharge and non-healing wound in the right upper abdomen along with an underlying lump. She had undergone open cholecystectomy 2 months earlier. She also experienced progressive loss of weight and appetite from a month after her surgery. There were no associated fever or bowel complaints. On physical examination, there was a 7 cm long transverse subcostal scar in the right hypochondrium with a pus discharging sinus at its lateral end. There was a fixed lump underlying the scar area. Her hematological and biochemical tests and plain skiagrams of the chest and abdomen were non-contributory. A contrast study carried out from the site of pus discharge [ - A] demonstrated mottled pooling of contrast in right hypochondrium [ - B]. Prompt entry of contrast into the stomach indicated a gastro-cutaneous fistula [ - C]. On contrast enhanced CT scan, the oral contrast came out from the fistulous opening within a few minutes of ingestion, further confirming a gastro-cutaneous fistula. A well-circumscribed mass with spongiform mottled lucencies suggestive of trapped air bubbles and some oral contrast within, was seen in the right sub-hepatic space abutting the pylorus [Figure and -D]. A diagnosis of gossypiboma causing a gastro-cutaneous fistula was made.\nAn exploratory laparotomy was performed. There were dense adhesions involving the stomach, transverse colon, hepatic flexure, and omentum. There was a fistulous communication with the anterior gastric wall and the presence of the sponge in the gastric cavity []. Adhesionolysis was carried out. The sponge was identified and removed. The necrotic anterior gastric wall was debrided and closed in layers. A feeding jejunostomy was performed to expedite enteral nutrition. Post-operative recovery was unremarkable and the jejunostomy was removed after 2 weeks.