Laparoscopic Treatment Of A Large Gossypiboma Complicated With Penetration Of The Intestinal Wall

We present a case of a large gossypiboma complicated with penetration of the intestinal wall laparoscopically treated by. Dr. Mocan Lucian at 3-rd Surgery Clinic Cluj Napoca, Romania. A 23 year old lady with a history of an cesarean section in another district presented in our Department (Clinica Chirurgie 3, Cluj Napoca) with a 12 month history of colicky abdominal pain and swelling in the hypogastric region associated with the lowering of her bowel motion and stool quantity but no absolute constipation. On clinical exam we observed a pale, wasted patient. The abdomen was full with a palpable, mobile, elastic mass in the hypogastric region. The rectal examination was normal. All lab tests including blood count, urinalysis, ESR, E&U and CXR were normal. An ultra sound scan of the abdomen and pelvis showed features of an abdominal tumor with a partial small bowel obstruction. The CT scan confirmed the presence of the tumor mass. An exploratory laparoscopy was planned founding a clean abdomen and a large intestinal mass surrounding one ileal loop as well as enlarged mesenteric lymph nodes. The mass was a rolled abdominal gauze pack (21X21 cm) penetrating the ileal wall. The mass was laparoscopically excised off the ileal wall (keeping the integrity of the intestinal wall despite the inflammation and structural damaged) and extracted using a small, 5 cm Pfannenstiel incision. The postoperative outcome was uneventful and she was discharged home in the 4-th postoperative day.