Transmural migration of surgical sponge evacuated by defecation

Abstract

A 40 years male had exploratory laparotomy for gunshot injury abdomen. He had jejunal resection and end to end anastomosis. His post-operative recovery was unremarkable and was discharged on 6^th post operative day. Three weeks after discharge, he came back in surgical OPD. He had off and on pyrexia and pus discharging from the upper end of laparotomy wound. He was admitted and the upper part of the incision opened in emergency department and wound washed with normal saline. The discharge of pus persisted alongwith episodes of fever. The abdominal examination was unremarkable and DRE was inconclusive. We suspected retained abdominal sponge. His plain X-ray abdomen was inconclusive and abdominal ultrasonography showed 7 x 5 cm cavity in upper abdominal wall at the site of pussy discharge, no other finding in rest of abdomen. On the next operating list, the wound in the upper abdomen was explored and the cavity containing pus washed with normal saline. No extension of the cavity found to the rest of the abdomen. Patient’s fever settled and pus from the wound decreased. Patient was discharged and advised dressing and follow-up visits to OPD. Seven days after discharge from the hospital, He appeared in OPD with complaint of lower abdominal pain. His abdomen was soft and rest of examination was unremarkable. Investigations were also inconclusive. He came in the evening and in the same night he defecated the abdominal sponge. His condition improved and was discharged after two days.