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This is a case report of a 23-year-old male who presented to a hospital in Aleppo with a few months’ history of abdominal pain and diarrhea associated with progressive weight loss and ultimate cachexia. Patient’s history is significant for a trauma laparotomy due to a blast injury with management of a colonic and orthopedic injuries. Three months later he underwent a second laparotomy for reversal of the stoma after which his symptoms started and gradually became worse. The abdominal pain attacks were so severe unresponsive to analgesics and he had lost around 30 kg. He underwent CT scan on presentation which showed small bowel obstruction and was taken down to the operating room (OR) for exploration. In the operating room a hard mass was palpated in the small bowel and a small enterotomy was done overlying the mass with retrieval of a large surgical pad, gossypiboma, from the lumen. The enterotomy was closed primarily and the patient did well postoperatively and was discharged home.

Pediatric surgery, as a specialty, pertains to the diagnosis, treatment and operative management of pediatric patients with congenital as well as acquired pathologies. The physiology and functional reserve of children is different than adults and this necessitates special considerations when dealing with this subgroup of patients. This includes careful anesthesia planning, perioperative care, as well as in-depth knowledge and appreciation of anatomic variations and operative techniques.

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