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.

Figure 2 Right hemi-colectomy. A huge laparotomy sponge (arrow-heads) can be seen on dissection of the surgical specimen which included a cluster of small bowel loops (sb) and the appendix (arrow).

Figure 3 Multi-detector contrast-enhanced computed tomography. An 80 mm thick maximum intensity projection (MIP) reconstructed image is shown; The laparotomy sponge (arrow-heads) is clearly depicted in the right flank extending from the ileo-cecal valve to the proximal transverse colon where the perforation occurred; Stomach (*) and jejunal loops (°) appear opacified by orally administered iodinated contrast medium (Gastrografin).