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Spontaneous transmural migration of retained surgical textile into both small and large bowel: a rare cause of intestinal obstruction

University College of Medical Sciences & Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi 110095, India

Correspondence: Satish K Bhargava, 201 Fancy Apartments, 19 Vasundhra Enclave, Delhi 110096, India. E-mail: skbhargava9731{at}rediffmail.com

Retained surgical textile is an infrequent but serious complication of abdominal surgery. Diagnosis is often delayed owing to non-specific clinical symptoms and inconclusive imaging features. Medicolegal implications further complicate the issue. We report a case of a 30-year-old woman who had previously undergone caesarean section and who presented with pain and features of intestinal obstruction. Contrast-enhanced CT revealed a heterogeneous ill-defined mass with mottled air densities lying within both the large and the small bowel. Barium study beautifully demonstrated the intraluminal mass in the transverse colon extending into the jejunum, with a fistulous communication between the two loops. To the best of our knowledge, this is the first reported case in which the gauze migrated simultaneously into the large and small bowel, and where the exact site of migration was clearly mapped out on pre-operative imaging studies.