Dear Sir, this is an interesting scenario. You mentioned that the gossipibioma was seen on endoscopy, so I assume it was within the gastric lumen? Gossipibiomas are known to erode through the bowel wall into the lumen. Please keep us updated on your case.

We published a similar case of gossipibioma in the gastric lumen, this was following open GJ for ulcer disease. The foreign body was extracted endoscopically in our case:

Palanivelu C, Rangarajan M, Rajan PS. Gossypiboma causing ‘afferent loop syndrome’ and its endoscopic retrieval ... Endoscopy 2007; 39: E1

thanks,will do

In my opinion, the choice between open, laparoscopic or endoscopic treatment of surgical complications should generally be based on one's experience and familiarity with each technique. All methods are acceptable in the literature. Sometimes, however, in an attempt to go for the least invasive technique, for the patient's sake, things sadly get even more complicated... And every time management is more and more difficult.

I would personally choose open exploration of the abdomen via a supraumbilical midline incision. Maybe not the best option in terms of aesthetic result, but certainly the safest choice to solve a problem.

In case it turns out to be a gossypiboma indeed, would you tell the patient the truth? Or choose not to expose a colleague and a case of malpractice? Because retained surgical sponges are an unfortunate, yet totally preventable, complication when the surgical team is careful.

I agree with Dimitrios. Is there a fistula?  sadly interesting.

My experience was published a few years ago.

If a foreign body is present without doubt, it should be extracted if the surgical risk is not prohibitive. Open abdominal exploration seems the best approach. Once you have diagnosed it, you have to inform the patient about what happened and what you are intending to do to help her. Failure to do so is potentially dangerous to her and to yourself.

Operate