Transmural Migration of a Retained Surgical Sponge Causing Contained Ileal Perforation

Retained surgical sponges are rare postoperative complications that may remain clinically silent or present late with nonspecific symptoms. Transmural migration into the bowel is an uncommon sequela, resulting from a chronic inflammatory reaction and gradual erosion of the bowel wall, and may manifest as obstruction or contained perforation. We report a case of a 54-year-old woman who presented three months after a total abdominal hysterectomy with persistent post-surgical abdominal pain, vomiting, weight loss, and recent-onset constipation. Contrast-enhanced computed tomography (CT) demonstrated a circumferential mural thickening of a distal ileal loop with a serpiginous hyperdense structure corresponding to a radiopaque marker, internal mottled gas lucencies producing a spongiform appearance, intramural air foci, adjacent extraluminal air, and surrounding mesenteric fat stranding, consistent with a contained ileal perforation due to the transmural migration of a retained surgical sponge. Surgical resection with primary anastomosis confirmed the diagnosis. This case highlights characteristic CT features and underscores the critical role of imaging in the timely recognition of this rare postoperative complication.