Colonic perforation by a transmural and transvalvular migrated retained sponge: multi-detector computed tomography findings.
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.
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Luigi
L
Camera
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Marco
M
Sagnelli
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Paolo
P
Guadagno
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Pier Paolo
PP
Mainenti
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Teresa
T
Marra
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Maria
M
Scotto di Santolo
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Landino
L
Fei
Luigi Camera, Marco Sagnelli, Maria Scotto di Santolo, Marco Salvatore, Department of Radiology, University "Federico II", 80131 Naples, Italy.
Marco
M
Salvatore
D015746:Abdominal Pain / Q000209:etiology; D003106:Colon / Q000473:pathology*; D003287:Contrast Media / Q000737:chemistry; D005243:Feces; D005260:Female; D005547:Foreign Bodies; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D007813:Laparotomy; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010528:Peristalsis; D015503:Surgical Sponges / Q000009:adverse effects*
D003287:Contrast Media
Acute abdomen; Colonic perforation; Multi-detector computed tomography; Retained sponge; Transmural migration