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She had undergone emergency lower segment cesarean section for obstructed labor four months back with intraoperative hemorrhage managed successfully with blood transfusion and pressure application. Abdominal examination revealed a i m at the doctor s now he a new medicine for me lump of size 15 x 10 cm in the left lower abdomen with the lower border going into the pelvis.

Per-speculum and per-vaginal examination showed the vaginal cavity filled with pus-mixed fecal content with a bimanually palpable mass in the left fornix. Ultrasonography (USG) of the pelvis revealed air foci in the endometrial cavity with multiple surrounding loculated abscesses and a hyperechoic mass with posterior acoustic shadowing in the left parauterine space (Figure 1A). Magnetic resonance imaging (MRI) revealed a fistulous tract connecting the left cornu of the uterus with the adjacent sigmoid colon on T2-weighted short-tau inversion recovery (T2w-STIR) imaging (Figures 1B-1C) and a mass with whorled stripes in a fluid-filled cavity with low signal in the peripheral wall on axial T2-weighted turbo spin-echo (TSE) imaging suggestive of a foreign body (Figure 1D).

The patient was planned for exploration with consent for stoma and hysterectomy. Laparotomy revealed a thick-walled abscess cavity in the lower abdomen surrounding a surgical sponge in the left parauterine space (Figure 2).

It had eroded the anterior sigmoid colonic wall i m at the doctor s now he a new medicine for me the left cornu of the uterus (Figure 3).

It was removed after adhesiolysis followed by resection of colouterine fistula (Figure 4) with end sigmoid colostomy due to unhealthy bowel and peritonitis. The postoperative course was uneventful.

The patient has been doing well at two months of follow-up and is waiting for colostomy takedown. Site of gossypiboma with colo-uterine fistula. Note the adjacent openings on the medial aspect of the adhered sigmoid colon and the left cornu of the uterus. In our patient, the apparent risk factor was the emergency indication of the cesarean section and the intraoperative hemorrhage. Clinical i m at the doctor s now he a new medicine for me depends upon the location of the foreign body and the type of inflammatory response.

The fibrous type presents with adhesions, encapsulation, and eventually granuloma formation, whereas the exudative type occurs early in the postoperative period, resulting in abscess formation and may involve secondary bacterial infection. In our case, it may be inferred that the aseptic fibrotic response led to the formation of a granulomatous mass; continued inflammation caused adhesion of sponge material to the adjacent sigmoid colon and the uterus, which could have gradually weight the adjoining walls creating a colo-uterine fistula with superimposed infection.

Although X-ray, USG, computed tomography (CT), MRI, colonoscopy, hysteroscopy, and others aid in the diagnosis, they are often non-specific. On plain X-ray, gossypiboma may be identified as curved or banded radio-opaque lines if it has a radiological marker. MRI is a versatile, detailed, and accurate diagnostic tool in diagnosing a retained foreign object as well as a colouterine fistula.

In our patient, MRI helped in establishing the diagnosis. Although en bloc resection or adding hysterectomy may be justified in malignancy, in benign conditions, the need for a hysterectomy has not been established. However, the patient should be counseled in the perioperative period regarding the high risk of infertility although one may still be able to conceive. In the present case, retrieval of the foreign object with excision of the i m at the doctor s now he a new medicine for me segment and end colostomy was done in the best interest of the patient.

Gossypiboma should be included in the differential diagnosis of soft tissue masses or localized abdominal pain in a patient with a history of prior operation. The diagnosis is often difficult to make. Fecal discharge per vaginum can be a presentation of a rare pathology like colouterine fistula. Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, INDDepartment of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, INDDepartment of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, INDDepartment of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, INDHuman subjects: Consent was obtained or waived by all participants in this study.

Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an yeast infection in the submitted work.

Other relationships: All authors have declared that there are no other relationships or activities that could appear i m at the doctor s now he a new medicine for me have influenced the submitted work. The authors are grateful to Dr. Mohit Mangla from the Department of General Surgery, Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), and Dr. Ashish Verma from the Department of Radiology, IMS, BHU, for their assistance in the management of the patient and in completion of the manuscript.

Jha P K, Verma A, Ansari M A, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4. This link will take you to a third party website that is not affiliated with Cureus, Inc. Please note that Cureus is not responsible for any content or activities contained within our partner or affiliate websites.

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