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A 51-year-old man with a history of hypertension, hypercholesterolemia, and nephrolithiasis presented to the emergency department with left flank and left upper quadrant abdominal pain. He stated that “I think I have a kidney stone blocking my kidney” but denied nausea, vomiting, fever, dysuria, hematuria, or weight loss. He had no history of chronic abdominal pain. Past surgical history was noteworthy for emergency exploratory laparotomy and splenectomy for blunt trauma 14 years prior. Physical examination revealed a comfortable-appearing patient in no acute distress. His temperature was 36.8°C; pulse, 77/min; and blood pressure, 125/86 mm Hg. Abdominal palpation elicited only mild epigastric tenderness without masses or rebound. There was no costovertebral angle tenderness.
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Gossypiboma (retained surgical sponge)
C. Perform an exploratory laparotomy and excision of the mass
The key to the correct diagnosis is the remote history of a trauma laparotomy and the CT scan scout image that shows the characteristic finding of a radiopaque marker associated with a retained surgical sponge (Figure 2). All surgical sponges are equipped with such a marker, which manifests radiographically as a convoluted hyperdensity. These abdominal lesions may be confused with a gastrointestinal stromal tumor or other gastrointestinal malignancies. Since the lesion appears radiographically to be outside the lumen of the gastrointestinal tract, EGD has no role. Without a confirmed diagnosis of malignancy, laparoscopy with peritoneal washings to identify occult metastases would be premature. An interventional radiology–guided biopsy is unnecessary, given the early recognition of the radiopaque marker associated with gossypiboma.
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Corresponding Author: Joseph M. Vitello, MD, Department of Surgery, Jesse Brown Veterans Administration and Medical Center, 820 S Damen Ave, Chicago, IL 60612 (firstname.lastname@example.org).
Published Online: June 10, 2019. doi:10.1001/jama.2019.6849
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for providing permission to share his information.
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