Abstract

Post-operative retention of surgical sponges occurs in 1 in 5,500 cases. Migration from the abdomen to the intestines occurs infrequently. The incidence is unknown due to poor reporting. A 38 year old nullipara presented with a four month history of increasingly painful abdominal swelling following myomectomy. She had a history of low grade fever, nausea and constipation. On examination, she was afabrile, in mild/moderate distress and chronically ill-looking. Abdominal examination showed an 8 cm × 6 cm firm, mobile and tender, right sided para-umbilical mass with a discharging sinus along the lower 1/3 of the midline sub umbilical surgical wound. Ultrasound suggested an abdominal-pelvic abscess. Exploratory laparotomy revealed severe fibrinoid adhesions involving the fundus of the uterus, sigmoid colon, ascending colon and anterior abdominal wall. Dissection revealed that two pieces of sanitary pads in the ascending colon formed the right sided para-umbilical mass palpated on abdominal examination. There were bowel perforations involving the illeocecal complex and ascending colon. The ovaries and fallopian tubes were not visualized. The sanitary pads were removed; right hemicolectomy, ileocolic anastomosis and copious abdominal lavage were performed. By two weeks after surgery she developed an enterocutenous fistula (ECF) that healed spontaneously within two weeks. Meticulous surgical techniques including surgical sponge and instrument counts and intracavity sponge tagging should be observed while working in body cavities.