Der vergessene Fremdkörper als Ursache einer postoperativen Darmobstruktion

Zusammenfassung

Während einer Operation einen Fremdkörper intraabdominell zu vergessen, kann zu erheblichen klinischen Auswirkungen mit Re-Laparotomien führen. Wir berichten über eine postoperative Darmobstruktion 6 Monate nach totaler abdomineller Hysterektomie. In der präoperativen Diagnostik wurde eine Gaze im linken Unterbauch entdeckt, die in der Gegend der Ileozoekalklappe lag. Bei operativer Exploration zeigte sich, dass der Fremdkörper durch das Ileum getreten und dann durch Peristaltik bis in das Sigma weitergewandert war. Die gedeckt perforierte Dünndarmschlinge wurde reseziert, der Fremdkörper selbst konnte manuell bis ins Rektum ausgetrieben und transanal entfernt werden. Der postoperative Verlauf gestaltete sich komplikationslos.

Abstract

Background: Forgetting a foreign body in the abdominal cavity is an unpleasant and avoidable situation. It usually occurs when the preventive protocols are not followed precisely. In such a case clinical consequences are unpredictable and relaparotomy may become necessary. Case presentation: We present the case of a temporary intestinal obstruction six months after a transabdominal hysterectomy. Diagnostic workup revealed a laparotomy-gauze left in the abdominal cavity at the previous operation. Exploration showed that the gauze was actually located in the intestinal lumen. The inflammatory reaction elicited by the foreign body eroded the intestinal wall and allowed its intraluminal migration. The gauze moved distally due to peristalsis until it became trapped in the ileocecal valve causing obstruction. When it finally passed through the valve the obstruction was relieved. Intraoperative maneuvers advanced the foreign body further forward until it was removed transanally. Conclusion: The formal processes - counting the gauzes continually and double crossing the counting - must be kept in every laparotomy to avoid the unpleasant experience of gauze remaining in the peritoneal cavity. In such an unfortunate case traditional open surgery provides a safe solution to the patient's problem.

Ileus - postoperativ verbliebener Fremdkörper - chirurgische Gaze

Retained foreign bodies - surgical gauzes - intestinal obstruction

Literatur

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