Small bowel obstruction and ileocolic fistula caused by post-myomectomy Gossypiboma transmural migration: A case report and review of the literature

Introduction: Post-myomectomy Gossypiboma causing Ileo-colic fistula is tremendously rare; it may present as a tumor and stand a diagnostic challenge. The duration between the primary procedure and the presentation is unpredictable. Case presentation: A 37-year-old Sudanese/African woman presented with a 4-month history of left iliac fossa mass, pain, anorexia, and persistent, recurrent vomiting with episodes of diarrhea during the last month PTP. She had two gynecological surgeries. Abdominal X-ray & abdominopelvic CECT showed a left iliac fossa pelvic-abdominal collection, distal small bowel partial obstruction, and contrast passage from the small bowel to the sigmoid colon. Diagnosis retained foreign body with abscess causing distal ileal subacute obstruction and an ileosigmoid fistula. Surgical exploration, extraction of Gossypiboma with small bowel resection, primary sigmoid colon repair, and a protective transverse colon stoma were done. Six weeks later, colostomy closed after distal loopogram and flexible-sigmoidoscopy. Clinical discussion: A missed intraperitoneal gauze is the top differential diagnosis in patients presenting with acute abdomen after recent abdominal surgery. Transmural migration is slow but leads to difficult clinical situations, peritonitis, or fistulas. Our case reflects the light on the importance of the golden rule of perioperative gauze count and documentation. Thus, minimizing the surgical complications and preventing severe postoperative morbidities. Conclusion: Entero-colic fistula due to trans mural migration is not frequently encountered, and its complications can lead to morbidities and even mortality if not promptly diagnosed and treated. Strict adherence to the golden rule of counting and prevent such life-threatening complications and improves patients' safety.