Case Report
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World J Gastroenterol. Jun 7, 2013; 19(21): 3364-3368
Published online Jun 7, 2013. doi: 10.3748/wjg.v19.i21.3364
Foreign body retained in liver long after gauze packing
Jian Xu, Heng Wang, Zheng-Wei Song, Miao-Da Shen, Shao-Hua Shi, Wei Zhang, Min Zhang, Shu-Sen Zheng
Jian Xu, Zheng-Wei Song, Miao-Da Shen, Shao-Hua Shi, Wei Zhang, Min Zhang, Shu-Sen Zheng, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Jian Xu, Miao-Da Shen, Shao-Hua Shi, Wei Zhang, Min Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Heng Wang, VIP Department, Red Cross Hospital, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zhang M and Zheng SS designed the report; Xu J, Song ZW, Shen MD and Zhang M were attending doctors for the patients; Zhang M performed surgical operation, Xu J, Wang H, Shi SH and Zhang W organized the report; Xu J, Wang H and Zhang W wrote the paper.
Supported by Grants from the Technology Program of the Science Technology Department of Zhejiang Province, No. 2011C37087; and the National Natural Science Foundation of China, No. 81000065
Correspondence to: Shu-Sen Zheng, Professor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. shusenzheng@zju.edu.cn
Telephone: +86-571-87236601 Fax: +86-571-87236739
Received: March 10, 2013
Revised: April 17, 2013
Accepted: May 16, 2013
Published online: June 7, 2013
Abstract

This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient’s case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.

Keywords: Liver, Foreign bodies, Foreign-body migration, Foreign-body reaction, Surgical sponges

Core tip: We reported a case of foreign body retained in liver 39 years post perihepatic gauze packing. To our knowledge, this seems to be the longest time and first report of gossypiboma post gauze packing in literature. We classified foreign bodies retained in liver as 3 categories: penetrating, medical and migrated foreign bodies. Also, we presented a comprehensive review, which may greatly help a surgeon make clinical decision when patients presented with hepatic mass.