Intraluminal migration of retained surgical sponge as a cause of intestinal obstruction
29-year-old woman was referred by her gynecologist with a history of diffuse colicky abdominal pain, nausea, repeated vomiting, constipation and progressive abdominal distention for 7 days prior to hospitalization. She had undergone an emergency cesarean section 9 months previously at a private hospital and since that time she had been complaining of recurrent attacks of nonspecific abdominal pain and occasional episodes of vomiting especially after heavy meals from which she had lost 10 kg since delivery. The patient had attended emergency departments at different institutions with similar complaints and had been discharged home after each occassion, but her symptoms passed undiagnosed. Five days prior to admission, abdominal roentography was done at an emergency department for her abdominal complaint, which showed radio-opaque density in the pelvis (Fig. ), but it was mistakenly overlooked and she was discharged home with a diagnosis of nonspecific abdominal pain.\nUpon admission, she was afebrile, vitally stable, and her abdomen was distended and tympanic. Bowel sounds were increased in frequency and pitch. Digital rectal examination showed normal-colored stool. Laboratory investigations showed a white blood cell count of 10 700 cells/ml and a sodium level of 123 mmol/l, while other biochemical parameters were within normal limits. Abdominal roentography revealed dilated small intestinal loops with a finding of a radio-opaque density in the abdomen (Fig. ). A diagnosis of small intestinal obstruction most likely caused by retained surgical sponge was made. On abdominal exploration, the small intestine was dilated down to the ileum with an intraluminal mobile mass felt in the distal ileum (Fig. ). Before proceeding for mass removal, at around 80 cm from the duodenojejunal junction, there were two adjacent segments of the jejunum adherent to each other and both were adherent to the peritoneal wall by fibrous adhesions. Consequently, adhenolysis, enterotomy and removal of the mass, which was manually pushed there (Fig. ), followed by resection and anastomosis of the compromised jejunal segment, were achieved. The foreign body was found to be retained surgical sponge (Fig. ). However, apart from the isolated area of adhesion, exploration of the rest of the abdominal cavity did not show any lesions in the peritoneal cavity or perforation or fistula or pelvic collection. The authors concluded that the transluminal migration of the sponge most likely occurred from that adherent part of the jejunum. The postoperative period was uneventful and the patient was discharged on the seventh day of her hospitalization in good condition.