Abdul Naeem, Maria Aziz, Alia Mir, Hamid Sial, Muhammad Mudassir Shafiq, Iram Arshad.
Emergency Presentation of Abdominal Pain with Unusual Etiology.
J Rawal Med Uni Jan ;26(2):333-6.

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com