BackgroundRetained surgical instrument or sponge following an intra-abdominal surgery is a potentially dangerous medico-legal problem. The condition may manifest either as asymptomatic or severe gastrointestinal complications. Transmural migration of gossypiboma is a rare entity that may lead to bowel or visceral perforation, obstruction and/or fistula formation. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in stomach, ileum, colon, bladder, vagina and diaphragm. To our knowledge, this is the fifth case reported in the medical literature. However, we report the first case of the largest gossypiboma to date: a surgical gas compress measuring 20 × 20 cm which was successfully treated endoscopically.Case presentationA 52-year-old woman with obstructive jaundice was referred to our clinic. She had a medical history of cholecystectomy and T-tube drainage for choledocholithiasis a year previously. Abdominal ultrasonography and computed tomography revealed a mass located into the stomach which was compatible with gastric carcinoma. On the gastroscopy, a surgical gas compress that had totally migrated into the stomach was observed. The compress was successfully removed by gastroscopy through the esophagus. The recovery of the patient was uneventful.ConclusionTransmural migration of gossypiboma into the stomach should be considered in the differential diagnosis of any postoperative patient with obstructive jaundice symptoms. Endoscopy may be feasible for both diagnosis and treatment even though the size of gossypiboma is large. However, surgery should be considered in case of fixed reaction or incomplete migration of gossypiboma located into the stomach.

LSG is an effective procedure with good short-term outcomes. Both procedures described herein are equally effective with respect to the patient's return to daily activities. Increasing the distance from the resection line to the pylorus is associated with better weight loss but slightly increased symptoms of gastroesophageal reflux disease without a significant difference in complications.

<b><i>Background:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. <b><i>Methods:</i></b> Between June 2015 and April 2018, the patients’ data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, <i>n</i> = 46) and the peroral systemic steroid treatment group (group 2, <i>n</i> = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. <b><i>Results:</i></b> Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (<i>p</i> = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; <i>p</i> = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; <i>p</i> = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. <b><i>Conclusion:</i></b> Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.

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