A 75-year-old woman was admitted to our clinic with complaints of abdominal pain and
melena. She was taking lisinopril for hypertension and warfarin for atrial fibrillation.
Her medical history included laparoscopic cholecystectomy for acute cholecystitis
with gallstones 2 months previously. Beginning 4 weeks after cholecystectomy, and
for 4 weeks, she developed mild epigastric pain with subsequent melena. On physical
examination, she appeared pale and had epigastric tenderness. Laboratory test results
showed a hemoglobin of 10.9 g/dL and a hematocrit of 31.0%. The international normalized
ratio was 1.9. An EGD revealed a giant ulcer that extended from the pylorus to the
anterior wall of the duodenum, with a central foreign body (A). Based on her surgery history, we believed this to be a sponge that penetrated into
the duodenal bulb. Surgical consultation during the endoscopy led to laparotomy, which
included extraction of the gossypiboma, duodenal wedge resection, and primary intestinal
repair. The patient did well and was discharged home after a 12-day inpatient stay
(Video available online at www.giejournal.org).
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Publication history
Published online: September 24, 2012
Lawrence J. Brandt, MD, Associate Editor for Focal PointsIdentification
Copyright
© 2012 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
