Case Report
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World J Gastroenterol. Apr 21, 2014; 20(15): 4457-4461
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4457
Colonic perforation by a transmural and transvalvular migrated retained sponge: Multi-detector computed tomography findings
Luigi Camera, Marco Sagnelli, Paolo Guadagno, Pier Paolo Mainenti, Teresa Marra, Maria Scotto di Santolo, Landino Fei, Marco Salvatore
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University “Federico II”, 80131 Naples, Italy
Luigi Camera, Pier Paolo Mainenti, Institute of Biostructures and Bioimaging, National Research Council (CNR) - Via Tommaso De Amicis 95, 80131 Naples, Italy
Paolo Guadagno, Teresa Marra, Landino Fei, Gastrointestinal Surgery Unit-Second University School, 80131 Naples, Italy
Author contributions: Camera L designed the report and revised the manuscript; Sagnelli M drafted the manuscript; Guadagno P and Marra T performed the laparotomy; Mainenti PP and Scotto di Santolo M performed the literature search; Fei L and Salvatore M edited the manuscript.
Correspondence to: Luigi Camera, MD, Department of Radiology, University “Federico II”, Via S. Pansini, 80131 Naples, Italy. camera@unina.it
Telephone: +39-81-7463560 Fax: +39-81-5457081
Received: June 4, 2013
Revised: September 6, 2013
Accepted: September 15, 2013
Published online: April 21, 2014
Processing time: 316 Days and 14.3 Hours
Abstract

Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction. Once passed through the ileo-cecal valve, a retained sponge can be propelled forward by peristaltic activity and eliminated with feces. We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation. On physical examination, a generalized resistance was observed with tenderness in the right flank. Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery. In addition, a ring-shaped hyperdense intraluminal material was also noted. At surgery, the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure, but no diverticula were found. A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.

Keywords: Retained sponge; Transmural migration; Multi-detector computed tomography; Colonic perforation; Acute abdomen

Core tip: Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction. We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain. Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with additional evidence of hyperdense intra-luminal material. At surgery, a right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.