Complete transmural migration of a retained surgical sponge

Rationale: Intraluminal migration of a retained surgical sponge causing intestinal obstruction and fistula is extremely rare occurrence. Patient concerns: A case of a 35-year-old male, who complaining a diffuse abdominal pain beginning three days earlier. He also complained of occasional vomiting, nonspecific abdominal pain, and an unintentional 15 kg weight loss during the past 2 years. However, there were no clear findings in previous laboratory work. He had received an open appendectomy approximately 4 years earlier. Diagnoses: Retained surgical sponge. Interventions: A contrast-enhanced CT of the abdomen showed a clear invagination of the small intestine. However, intraoperatively, we could not find an intestinal segment with intussusception. After the adhesive intestine was detached, a jejunal−ileal cross-linked fistula was found. More surprisingly, a retained surgical sponge was found inside the ileal fistula when the cross-linked fistula was detached. Outcomes: The patient was discharged 7 days after surgery. Lessons: This is the first report showing an atypical image of a complete transmural migration of a retained surgical sponge mimicking intussusception.