Correct diagnosis is difficult because of the low sensitivit

Correct diagnosis is difficult because of the low sensitivity of diagnostic investigations. The sensitivity of the diagnostic tests ultrasound, computed tomography, and endoscopy is 32.6%, 42.6%, and 72.1%, respectively. Endoscopy can be advantageous when a toothpick is localized in the upper GI tract. Our patient, initially presented with urinary tract infection with left acute pyelonephritits. A foreign body between the stomach and the proximal jejunum with fistula formation was suspected, based on the abdominal computed tomography findings. Endoscopy subsequently confirmed it. Toothpicks are most frequently lodged in the lck inhibitor (23%), followed by the stomach (20%) and small bowel (18%). Toothpick ingestion may lead to GI hemorrhage, small or large bowel perforation, fistula formation, intestinal obstruction, sepsis, or other diseases. In our patient, the toothpick was lodged between the stomach and the proximal jejunum with a gastrojejunal fistula. Because of the perforation of the gastrojejunal fistula, endoscopic retrieval of the toothpick was not performed. According to Steinbach et al, 49%, 30%, and only 9% of cases of accidentally ingested toothpicks that caused severe GI injury were treated through laparotomy, endoscopy, and laparoscopy, respectively. In our patient, the previous abdominal operation may have resulted in severe intra-abdominal adhesion; therefore, an exploratory single-port laparoscopy was performed to retrieve the toothpick and successfully treat the gastrojejunal fistula.
Introduction Gossypiboma describes a reaction to a mass within the body composed of a retained nonabsorbable cotton matrix surrounded by a foreign body. The word is derived from the Latin gossypium (cotton) and the Kiswahili boma (place of concealment). Gossypiboma is underreported due to fear of medical malpractice lawsuits. Gossypiboma may cause various complications depending upon the location or exert no adverse effects, potentially being discovered months or even years after the primary surgery. The incidence rate of gossypiboma in patients who have undergone lumbar spine surgery is 0.7/10,000 patients. Here, we describe a case of spinal gossypiboma in a patient who complained of lower back pain. We also present a review of the relevant literature.
Case report A 79-year-old woman was admitted with the complaint of persistent lower back pain for 1 month. The pain was mild to moderate, with a pain score of 3–4 out of 10 on the Visual Analogue Scale. The pain was aggravated with movement and improved with rest. The lower back pain was dull and nonspecific. The patient had undergone spinal surgery for a herniated intervertebral disc at the L5–S1 level 10 years earlier at another institution. On admission, the patient’s general condition was healthy and afebrile. Physical examination did not reveal any increased warmth, swelling, or tenderness at the site of the previous surgery or at any place on the lower back. The straight-leg raising test was negative. Laboratory examinations showed no leukocytosis (white blood cell count: 7540/μL; reference range: 4000–10,000/μL) or other remarkable findings suggestive of infection. Computed tomography (CT) of the lumbosacral spine revealed a mixed-density mass measuring 4.6 cm×2.6 cm×2.7 cm that was located in the right paraspinal region at the level of S1–S2, with erosion of the sacrum (Figure 1). Magnetic resonance (MR) images of the lumbar spine revealed a well-defined mass located at the S1–S2 level. T1-weighted images showed low signal intensity, and T2-weighted images depicted a low-signal-intensity mass with a high-signal-intensity margin (Figure 2). We decided to perform surgery for the removal of the mass. During surgery, a mass composed of retained surgical gauze and granulation tissue was removed from the right paraspinal space (Figure 3). A specimen was sent for pathological examination, which revealed suture granuloma with foamy histiocytes, mild chronic inflammation, and old hemorrhage. The patient was diagnosed with gossypiboma. The patient’s postoperative course was uneventful, and positive feedback control recovered without any neurological deficits.