https://orcid.org/0000-0001-5918-8261
Abstract
Gossypiboma, also known as textiloma, is a retained surgical sponge and represents a rare but serious postoperative complication. Complete transmural migration into the intestinal lumen is extremely uncommon and may manifest as small bowel obstruction. We report the case of a 41-year-old woman with a history of cesarean section performed 10 months earlier who presented with diffuse abdominal pain, abdominal distension, and vomiting. Exploratory laparotomy revealed a 20 cm segment of ileum containing a mobile intraluminal mass, which was resected. Opening of the specimen demonstrated a malodorous retained surgical sponge. The patient received perioperative antibiotic therapy with ceftriaxone and metronidazole and was discharged on postoperative day 5 after an uneventful recovery, with no recurrence at one-month follow-up. Although computed tomography is considered the imaging modality of choice for diagnosis, urgent surgical intervention remains the definitive treatment. Intraluminal gossypiboma should be considered in the differential diagnosis of intestinal obstruction in patients.
Introduction
Gossypiboma, also known as textiloma, refers to a retained surgical textile material, most commonly a sponge, inadvertently left within the body after an operative procedure. Although its reported incidence ranges between 0.01% and 0.001% of intra-abdominal surgeries, it represents a serious clinical complication with important ethical and medicolegal implications [1, 2].
After abdominal or gynecological procedures, particularly emergency surgeries such as cesarean sections, the omentum may encapsulate the retained sponge, forming a dense inflammatory mass that limits its displacement [3]. In rare cases, complete transmural migration occurs, whereby the foreign body erodes through the intestinal wall and enters the bowel lumen. The ileum is the most frequently involved segment, often resulting in mechanical intestinal obstruction [4, 5].
Intraluminal gossypiboma is exceptionally uncommon, with only isolated case reports available in the literature. Clinical presentation may be delayed for months or even years after the index surgery, increasing the risk of complications such as obstruction, perforation, fistula formation, or sepsis [6]. This report describes a rare case of small bowel obstruction caused by an intraluminal gossypiboma following cesarean section and emphasizes the importance of preventive surgical measures.
Case description
A 41-year-old woman with a history of cesarean section performed 10 months earlier was referred to the emergency department with a presumptive diagnosis of complicated acute appendicitis versus subocclusive intestinal obstruction due to adhesions. She reported diffuse abdominal pain for two days, partially relieved with analgesics, followed by persistent vomiting, oral intolerance, and worsening pain localized to the hypogastrium and right iliac fossa.
On physical examination, the patient appeared pale and uncomfortable, with abdominal distension, decreased bowel sounds, and positive Blumberg and Guéneau de Mussy signs. Vital signs were stable, with a heart rate of 94 bpm, blood pressure of 110/70 mmHg, temperature of 37.8°C, respiratory rate of 20 breaths per minute, and oxygen saturation of 98% on room air. Laboratory tests showed anemia with a hemoglobin level of 9.07 g/dl and no leukocytosis. One unit of packed red blood cells was transfused preoperatively.
An exploratory laparotomy through a midline transumbilical incision revealed dense adhesions between the omentum, parietal peritoneum, and a small bowel loop. Approximately 330 cm distal to the ligament of Treitz, a 10 cm indurated ileal segment containing a firm and mobile intraluminal mass was identified. Due to marked inflammation and adhesions, a 20 cm segmental ileal resection was performed.
On opening the specimen, a foul-smelling elongated intraluminal mass consistent with a retained surgical sponge was found (Figs 1–3). An end-to-end ileoileal anastomosis was completed. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Follow-up at 1 week and 1 month showed complete recovery.
Terminal ileal segment with a visible intraluminal mass causing proximal dilatation. Note the edematous intestinal loop and the blockage of luminal content progression.
Longitudinal opening of the resected ileal segment showing a soft intraluminal mass with elongated morphology and foul odor, corresponding to a retained surgical sponge (gossypiboma).
Surgical dressing sponge extracted after intestinal resection, displayed on a sterile field. To the right, the affected ileal segment shows thickened serosa and dense surrounding adhesions.
Discussion
We summarized the reported cases of gossypiboma with transmural intraluminal migration published over the last 10 years, highlighting patient characteristics, index surgery, clinical presentation, diagnostic imaging, management, and outcomes (Table 1).
Comparison of reported cases of gossypiboma with transmural intraluminal migration in the last 10 years.
| Author (Year) | Age/Sex | Index surgery – interval | Location | Symptoms | Imaging studies | Treatment | Outcome |
|---|---|---|---|---|---|---|---|
| Adelyar M et al., 2025 [7] | 18 (F) | Open cholecystectomy, 40 days | Terminal ileum | Abdominal pain, distension, nausea, vomiting, 3-kg weight loss | Abdominal X-ray: intestinal obstruction | Laparotomy + ileal resection + ileo-ileal anastomosis | Favorable |
| Chauhan A et al., 2025 [8] | 35 (F) | Open cholecystectomy, 9 years | Distal ileum | Chronic abdominal pain, constipation | Abdominal ultrasound: unremarkable. Contrast-enhanced CT: intraluminal gossypiboma | Enterotomy + loop ileostomy | Favorable |
| Verma S et al., 2025 [9] | 50 (F) | Hysterectomy for fibroids, 9 months | Distal ileum | Nausea, distension, vomiting | Abdominal X-ray: intestinal obstruction. Contrast-enhanced CT: foreign body with air bubbles in distal ileum | Laparotomy + ileal resection + loop ileostomy | Favorable |
| Baset G et al., 2024 [10] | 26 (F) | Cesarean section, 7 months | Distal ileum | Colicky abdominal pain, nausea, vomiting, constipation | Abdominal/pelvic ultrasound: unremarkable. Abdominal X-ray: radiopaque material | Enterotomy + extraction + primary repair | Favorable |
| Agada H et al., 2023 [11] | 40 (F) | Laparotomy for acute abdomen, 7 months | Terminal ileum | Colicky abdominal pain, vomiting, distension, constipation | Abdominal X-ray: intestinal obstruction | Ileal resection + extraction | Favorable |
| Naiem M et al., 2021 [12] | 37 (F) | Laparotomy for uterine fibroid excision, 6 months | Distal ileum + ileosigmoid fistula | Left iliac fossa mass, pain, anorexia, recurrent vomiting and diarrhea | Abdominal X-ray: obstruction. Contrast CT: abdominopelvic collection, distal small bowel obstruction, ileosigmoid fistula, foreign body in left iliac fossa | Distal ileal resection + ileo-ileal anastomosis + colonic repair + proximal colostomy | Favorable |
| De Sousa J et al., 2020 [4] | 26 (F) | Laparotomy for advanced rectosigmoid cancer (sigmoidectomy, hysterectomy, BSO, Hartmann colostomy), 4 months | Terminal ileum | Chronic abdominal pain, distension | Upper endoscopy: unremarkable. Colonoscopy: polyps. Abdominal CT: ileal obstruction, no foreign body seen | Laparotomy + enterotomy + primary repair | Fatal |
| Adôrno I et al., 2019 [13] | 83 (M) | Open cholecystectomy, 6 months | Duodenum (first portion) | Abdominal pain, nausea, vomiting, distension, 6-kg weight loss | Upper endoscopy: gastric antral vascular ectasia, undigested food. Abdominal X-ray: gastric dilatation with hydro-air level and foreign body. Contrast CT: gossypiboma | Laparotomy + duodenotomy + extraction + primary repair + feeding jejunostomy | Favorable |
| Butt U et al., 2018 [14] | Middle-aged (F) | Open cholecystectomy, 6 months | Distal ileum | Abdominal pain, distension | Abdominal X-ray/ultrasound: unremarkable. Contrast X-ray: gossypiboma | Spontaneous rectal expulsion | Favorable |
| Kassi A et al., 2018 [15] | 40 (F) | Myomectomy, 3 years + two relaparotomies (post-hemorrhage and septic collection) | Ascending colon | Abdominal pain, nausea, vomiting, constipation | Abdominal X-ray: intestinal ileus | Right hemicolectomy + transverse colostomy + right ileostomy | Favorable |
| Zhou Y et al., 2017 [16] | 35 (M) | Open appendectomy, 4 years | Distal ileum with jejuno-ileal fistula | Abdominal pain, vomiting, 15-kg weight loss (2 years) | Contrast CT: small bowel intussusception | Intestinal resection + anastomosis | Favorable |
| Williams M et al., 2015 [17] | 70 (F) | Radical cystectomy, 1 year | Distal ileum | Abdominal pain, distension, vomiting | Abdominal X-ray: dilated loops, metallic foreign body. Contrast CT: intraluminal gossypiboma | Laparotomy + enterotomy + primary repair | Favorable |
Abbreviations: BSO, bilateral salpingo-oophorectomy; CT, computed tomography; F, female; M, male; yrs, years; mo, months.
Gossypiboma is a rare but potentially severe postoperative complication. While most retained surgical sponges remain encapsulated, complete transmural migration into the intestinal lumen is exceptional. Chronic inflammation, pressure necrosis, and gradual erosion of the bowel wall have been proposed as mechanisms underlying this process [4, 11].
The ileum is the most frequently reported site of intraluminal migration, likely due to its mobility and relatively narrow lumen, which predispose to obstruction once migration is complete [5, 10]. The interval between surgery and symptom onset is highly variable, ranging from weeks to several years, which contributes to diagnostic difficulty [6, 18].
Clinical presentation is often nonspecific and may mimic other causes of acute abdomen or intestinal obstruction. Computed tomography is considered the imaging modality of choice, as it can demonstrate a spongiform mass with gas bubbles or a well-defined intraluminal foreign body [13]. However, in patients with peritoneal signs or clinical instability, immediate surgical exploration is indicated, as occurred in the present case.
Surgical treatment depends on intraoperative findings and includes enterotomy with extraction or segmental bowel resection with primary anastomosis [11, 12]. Prognosis is generally favorable when diagnosis and treatment are not delayed.
Prevention remains the most effective strategy. Risk factors for retained surgical items include emergency procedures, unexpected intraoperative events, prolonged surgeries, and obesity. Strict adherence to sponge counting protocols, routine use of radiopaque sponges, and selective intraoperative imaging in high-risk situations are essential to reduce this preventable complication [14–17].
Conclusion
Intraluminal gossypiboma due to complete transmural migration is a rare but serious cause of small bowel obstruction. It should be considered in the differential diagnosis of intestinal obstruction in patients with a history of previous abdominal surgery, even when the interval since the index procedure is long. Early recognition and prompt surgical management are critical for favorable outcomes. Ultimately, strict preventive measures remain paramount to avoid retained surgical items.
Author contributions
Caballero-Alvarado J: Conceptualization, surgery, drafting of the manuscript. Acevedo Valdiviezo J: Data curation, methodology, surgical assistance. Zavaleta-Corvera C: Critical revision, methodology, supervision, corresponding author. Lau-Torres V: Literature review, visualization, editing. Lozano-Peralta K: Data collection, editing, manuscript preparation.
Conflicts of interest
The authors declare no conflicts of interest.
Funding
The authors received no specific funding for this work.
Ethical aspects
The authors certify that they have followed institutional protocols regarding patient data publication and obtained informed consent for the case report and associated images.
References
Chauhan A, Kumar S, Singh PK. Gossypiboma-intraluminal foreign body without bowel obstruction: a rare case report. Int Surg J
Verma S, Kumar R. Complete intraluminal migration of gossypiboma presenting as small bowel obstruction: A case report. Int J Surg Case Rep
