Intestinal obstruction due to migrated surgical gauze (gossypiboma) 1 year after cesarean section: a rare case report

Introduction and importance: Gossypiboma, the retention of surgical gauze after an operation, is an uncommon but serious complication. While many cases remain localized within the abdominal cavity, transmural migration of the gauze into the bowel lumen particularly the terminal ileum is exceedingly rare. This report describes a unique presentation of complete intestinal obstruction caused by intraluminal migration of a retained surgical gauze 1 year after cesarean section. Case presentation: A 37-year-old woman presented with abdominal pain, vomiting, distension, and failure to pass stool 1 year after a cesarean delivery. Imaging suggested intestinal obstruction. Emergency laparotomy revealed a retained surgical gauze that had migrated into the terminal ileum, necessitating bowel resection and anastomosis. The patient recovered well postoperatively and remained complication-free on follow-up. Clinical Discussion: Transmural migration of gossypiboma into the terminal ileum is exceptionally rare. As reported in similar cases, chronic inflammation drives erosion into the bowel, complicating diagnosis – especially without CT. Consistent with literature, surgical extraction with resection was required due to significant ileal wall compromise. Conclusion: This case underscores the importance of vigilance in preventing retained surgical items. Strict adherence to sponge counts, use of radiopaque markers, and surgical safety checklists are crucial to avert this avoidable but potentially devastating complication.