At the focal point| Volume 76, ISSUE 6, P1246, December 2012

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A rare cause of upper GI hemorrhage: an uncorrupted sponge migrating into the duodenal bulb (with video)

Published:September 24, 2012DOI:
      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
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