Abdominal Intraluminal Gossypiboma: Demographics, Predictors of Intraluminal Site, Diagnostic and Treatment Measures

Figures & data

Figure 1 CT scan (A) axial view and (B) coronal view indicating dilation of the distal bowel loops that contained impacted fecal material and multiple linear dense radiopaque material (red arrow) associated with fat stranding with suspected foreign body.

Figure 2 (A–C) Intraoperative laparotomy and sponge extraction.

Table 1 General Demographic and Patients’ Characteristics

General Demographic and Patients’ Characteristics Variables	Number	Percent (%)
	Mean ± SE
Sex
Male	21	22.3
Female	73	77.7
Age (y)	40.4 ± 1.45
Clinical Presentation
Intestinal obstruction	58	61.7
Abdominal mass	9	9.6
Abdominal pain	22	23.4
Diarrhea	5	5.3
Anorexia and weight loss	17	18.1
Infections and systemic response	13	13.8
Fistulas and discharge	11	11.7
Bleeding	3	3.2
Pass per rectum	2	2.1
Causative Operation
Cholecystectomy	31	33
Appendectomy	6	6.4
Hysterectomy	23	24.5
Cesarean section	16	17
Exploratory laparotomy	10	10.6
Nephrectomy	3	3.2
Gastrectomy	1	1.1
Posterior sagittal anal repair	1	1.1
Hepatic Hydatid cyst excision	1	1.1
Colectomy	1	1.1
Splenectomy	1	1.1
Causative Operation Classified by the Specialty
Hepato-biliary surgery	33	35.1
Gastrointestinal surgery	9	9.6
Obstetric and gynecological surgery	39	41.5
Urological surgery	3	3.2
Exploratory laparotomy	10	10.6
Time frame from operation to presentation(months)	35.16 ± 6.67

Abbreviation: SE, standard error.

Table 2 Diagnostic and Treatment Measures

Diagnostic and Treatment Variables	Number	Percent (%)
	Mean ± SE
Diagnostic Modalities	Number of Utilizations	Percent (from Number of Utilizations)
Barium Study
Used and Conclusive for gossypiboma	2	9.5
Used and Not conclusive for gossypiboma	19	90.5
Endoscopic Assessment
Used and Conclusive for gossypiboma	22	73.3
Used and Not conclusive for gossypiboma	8	26.7
Ultrasound
Used and Conclusive for gossypiboma	5	9.8
Used and Not conclusive for gossypiboma	46	90.2
CT Scan
Used and Conclusive for gossypiboma	33	56.9
Used and Not conclusive for gossypiboma	25	43.1
Abdominal XRay
Used and Conclusive for gossypiboma	18	34.6
Used and Not conclusive for gossypiboma	34	65.4
MRI
Used and Conclusive for gossypiboma	1	25.0
Used and Not conclusive for gossypiboma	3	75.0
PET Scan
Used and Not conclusive for gossypiboma	1	100
Specific Intra-Luminal Site (Missing 4 Cases)
Stomach	9	10.0
Duodenum	5	5.6
Jejunum	13	14.4
Ilium	34	37.8
Colon	9	10.0
Rectum	4	4.4
Stomach + Duodenum	3	3.3
Duodenum + Ilium	1	1.1
Jejunum + Ilium	5	5.6
Colon + Ilium	6	6.7
Duodenum + Colon	1	1.1
Treatment
Exploratory Laparotomy	73	77.7
Endoscopic extraction	8	8.5
Expulsion per rectum	12	12.8
At autopsy	1	1.1

Abbreviations: SE, standard error; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography.

Table 3 Predictors for Intraluminal Migration Site

Variable	Stomach	Small Bowel	Large Bowel	Stomach & Small Bowel	Small & Large Bowel	P-value
Frequency (%)	9 (10.0)	58 (64.4)	13 (14.4)	3 (3.3)	7 (7.8)	–
Sex, n (%)
Male	0 (0.0)	14 (73.7)	5 (26.3)	0 (0.0)	0 (0.0)	NS
Female	9 (12.7)	44 (62.0)	8 (11.3)	3 (4.2)	7 (9.9)
Clinical Presentations, n (% from the Total Cases Presented with)
Intestinal obstruction (and gastric outlet obstruction)	7 (12.5)	40 (71.4)	4 (7.1) ↓	3 (5.4)	2 (3.6)	0.013
Abdominal mass	1 (11.1)	5 (55.6)	0 (0.0)	0 (0.0)	3 (33.3) ↑	0.036
Abdominal Pain	0 (0.0)	15 (68.2)	3 (13.6)	0 (0.0)	4 (18.2)	NS
Diarrhea	0 (0.0)	2 (40.0)	2 (40.0)	0 (0.0)	1 (20.0)	NS
Anorexia and Weight loss	4 (23.5)	11 (64.7)	1 (5.9)	1 (5.9)	0 (0.0)	NS
Infection and systemic response	2 (16.7)	7 (58.3)	3 (25.0)	0 (0.0)	0 (0.0)	NS
Fistulas and Discharge	1 (11.1)	4 (44.4)	3 (33.3)	0 (0.0)	1 (11.1)	NS
Bleeding	0 (0.0)	2 (66.7)	1 (33.3)	0 (0.0)	0 (0.0)	NS
Pass per rectum	0 (0.0)	0 (0.0)	2 (100.0) ↑↑	0 (0.0)	0 (0.0)	0.017
Causative Operation, n (% from the Total Cases Underwent the Surgery)
Hepato-biliary	8 (24.2) ↑↑	19 (57.6)	2 (6.1)	3 (9.1) ↑	1 (3.0)
Gastrointestinal	1 (11.1)	6 (66.7)	2 (2.22)	0 (0.0)	0 (0.0)
Gynecological	0 (0.0) ↓↓	25 (67.6)	6 (16.2)	0 (0.0)	6 (16.2) ↑	0.024
Exploratory Laparotomy	0 (0.0)	5 (62.5)	3 (37.5)	0 (0.0)	0 (0.0)
Urological	0 (0.0)	3 (100.0)	0 (0.0)	0 (0.0)	0 (0.0)
Diagnostic Methods, n= Used and Conclusive for the Diagnosis (%)
Barium study	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	2 (100.0) ↑	0.01
Endoscopy	7 (31.8)	6 (27.3)	4 (18.2)	2 (9.1)	3 (13.6)	NS
Ultrasound	0 (0.0)	2 (40.0)	0 (0.0)	0 (0.0)	3 (60.0) ↑↑	0.016
CT scan	3 (9.4)	17 (53.1)	5 (15.6)	1 (3.1)	6 (18.8)	NS
Abdominal X-ray	0 (0.0)	11 (64.7)	5 (29.4)	0 (0.0)	1 (5.9)	NS
MRI and PET scan						–
Age (mean ± SE) years	44.2 ± 4.2	42.4 ± 1.8	37.7 ± 5.2	32.0 ± 6.0	34.1 ± 3.4	NS
Time frame (mean rank) months	38.7	47.1	34.7	11.0	43.0	NS

Abbreviations: SE, standard error; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography; NS, not specific.