A rare case of three gossypibomas in one patient following an emergency cesarean section: case report

Gossypiboma refers to a retained surgical gauze or sponge, a rare but serious complication following surgery. Although typically involving a single retained item, we report an unprecedented case of three transmural gossypibomas in a single patient following an emergency cesarean section.

A 28-year-old female presented with 4 months of abdominal pain, distension, and alternating constipation and diarrhea, along with weight loss and persistent vomiting. Examination revealed ascites and palpable masses. CT imaging showed a sigmoid mass with a small bowel-colonic fistula. Colonoscopy revealed a foreign body protruding through the sigmoid colon wall, and small gauze was extracted. Subsequent exploratory laparotomy identified a complex entero-colic fistula. Two additional gauzes - one small and one large - were retrieved from within the bowel lumen. The involved bowel segments were resected, and the patient recovered uneventfully.

This case illustrates a rare presentation of multiple retained surgical gauzes causing transmural migration and fistula formation. The use of non-standard, non-radio-opaque gauze delayed diagnosis and increased risk. The patient's symptoms were non-specific, and endoscopic findings were misleading due to intact mucosa. The case underscores the severe consequences of inadequate surgical protocols and highlights the need for standardized surgical materials and checklist adherence.

This is the first documented case of three retained gossypibomas in a single patient. It emphasizes the critical importance of surgical safety measures, including complete sponge counts, use of radio-opaque materials, and strict adherence to the World Health Organization Surgical Safety Checklist, especially in low-resource settings.