Colo-cutaneous fistula and gossypiboma - learning from errors

An accidentally retained surgical sponge (gossypiboma) within the abdomen can result in a wide spectrum of clinical presentations. These manifestations are attributable to foreign body reaction, fistula formation, and transmural migration. We report an uncommon presentation of gossypiboma complicated by a colo-cutaneous fistula. A 20-year-old woman presented with complaints of fecal discharge from an abdominal surgical scar. The patient had undergone an emergency cesarean section 10 weeks earlier. Radiological imaging revealed a spongiform mass consistent with gossypiboma perforating into the sigmoid colon, with a fistulous tract extending to the skin. Computed tomography of the abdomen and pelvis demonstrated an intraperitoneal, heterogeneous, spongiform mass abutting the sigmoid and descending colon, along with a contrast-opacified fistulous tract tracking to a focal midline defect. The patient underwent laparotomy with resection of the perforated segment of the sigmoid colon and was discharged on postoperative day 21. A high index of suspicion is required in postoperative patients presenting with unexplained or unresolved symptoms. Strict adherence to multiple safety checks in the operating room is essential to prevent retained foreign bodies and avoidable human error.