Colonic perforation by a transmural and transvalvular migrated retained sponge: Multi-detector computed tomography findings

Figure 1 Multi-detector contrast-enhanced computed tomography. Transverse images of the lower abdomen are shown (A-D). A-B: Concentric thickening of the bowel wall can be seen at the level of both the ascending and proximal transverse colon (arrow-heads) with evidence of several out-pouchings and associated hyperplasic ileo-colic lymph-nodes; In B a small air-fluid collection is also depicted within the mesenteric fat with associated fat-stranding (arrow); C: At a more caudal level, extra-luminal air can also be seen, as best shown with pulmonary window settings (D). Retrospectively, a cluster of small bowel loops (arrow) is noted proximal to the cecum. There is evidence of hyperdense ring-shaped intra-luminal material in all images; Orally administered iodinated contrast medium (Gastrografin) can be seen in the small bowel loops which appear mildly dilated.