Hidden Retained Surgical Sponge with Intestinal Migration: A Rare Case Report

Introduction and importance: Retained surgical items are mistakenly left items used during surgery. They are not always radiopaque and in literature there are numbers of case reports that were not found by X ray. Transmigration of the retained surgical item to the small intestine is one of the possible outcomes rarely seen in patients. Case presentation: we present a case 32-year-old male with a history of open appendectomy one year ago presented to the emergency department with fever and diffuse abdominal cramps, which worsened after meals. Clinical discussion: Lab tests, abdominal and pelvis sonography, x-rays and CT scan and small intestine series all were unremarkable and only after defecation of a surgical gauze with blue marker, the diagnosis was made. Conclusion: In all missed items at the end of operation standard counting protocols must be considered and if we couldn't find the missed item never forget the meticulous follow ups because of a great chance of non-opaque item existence, in extremely rare cases the sponge could entered the bowels without obstruction or perforation and eventually defecated.