Duodenal gossypiboma following complicated cholecystectomy - A rare cause of gastric outlet obstruction

Introduction and importance: A surgical sponge, left accidentally inside a patient's body remains an infrequent but serious surgical complication. The retained sponges can lead to significant morbidity and mortality. Case presentation: A 40 year old female patient presented with recurrent pain in epigastric region associated with postprandial vomiting. The patient had underwent a difficult laproscopic conversion to open cholecystectomy 2.5 months ago in another hospital. Physical examination revealed previous surgical scar with tenderness over right hypochondrium. CECT abdomen showed thickening of gastric antropyloric region with possibility of neoplasia. An Upper GI endoscopy showed a large gossypiboma in antral region. With failed endoscopic retrieval, patient underwent an Exploratory Laparotomy with removal of the surgical compress via a duodenotomy and thus the final diagnosis of gossypiboma was made. Clinical discussion: Gossypiboma or textilomas are infrequent complications of surgery leading to significant morbidity and mortality, medicolegal consequences and lawsuits against the surgeon and hospital. Conclusion: Gossypiboma eroding into duodenum presenting as gastric outlet obstruction, usually diagnosed and retrieved endoscopically but surgical removal is required for failed endoscopic management.