laparoscopy is widely used as a tool in many clinical situations allowing for diagnosis and/or surgical management in a minimally invasive fashion .
nonetheless , attention to surgical technique is paramount to avoid both short and long term complications .
a 32-year - old woman had a laparoscopy and a reported left salpingoophorectomy for benign disease of the ovary in september , 1994 . shortly thereafter , in january , 1995 , she was diagnosed with an intrauterine pregnancy and delivered in october of 1995 by spontaneous vaginal delivery .
however , at the time of laparotomy , the patient was found to have a retained foreign body from her prior laparoscopy in the right lower quadrant with a pelvic abscess and evidence of prior right salpingoophorectomy .
although laparoscopy is usually done on an outpatient basis , complications can manifest several weeks or months later .
this case illustrates and reminds us of the importance of adherence to surgical laparoscopic principles .
these include direct visualization when removing equipment and a complete count of surgical instrumentation to confirm the integrity of such at the end of each procedure .
operative time is acceptable and recovery periods are significantly less than in open procedures with no significant difference in morbidity and/or mortality , even in pregnancy . a 32-year - old white woman presented to the gynecologic emergency room on november 21 , 1995 , complaining of tenderness and swelling of her right lower quadrant for three days . at that time she was four weeks postpartum from a spontaneous vaginal delivery .
her surgical history was significant for a laparoscopy done in september of 1994 in vienna , austria , where a left salpingoophorectomy reportedly was performed for an ovarian cyst .
pelvic examination revealed a normal uterus with a right adnexal mass approximately 8 cm in size , and exquisitely tender to palpation .
abdominopelvic ct scan revealed a 5.5 cm  4 cm  5.3 cm right adnexal mass , inflammatory in nature .
in addition to this , a 4.3 cm  6 cm  3.4 cm mass was superior to the first mass , in the right lower quadrant , and also inflammatory in nature .
the patient was taken to the operating room by the gynecologic service for an exploratory laparotomy .
intraoperatively , a normal left adnexae was found , not consistent with the patient 's history of left salpingoophorectomy . on the right side
there was a large , 10 cm  12 cm inflammatory mass with the appearance of an abscess . clearly above this mass ,
a 3 cm  2 cm portion of synthetic tubing was found enveloped by omentum ( figure 1 ) .
a partial omentectomy and removal of foreign body was performed , along with an excision of the right pelvic abscess and appendectomy .
antibiotics were continued until the patient was afebrile for 48 hours . by postoperative day number five the patient was tolerating a regular diet and ambulating without assistance .
the patient was seen in the postoperative clinic at four weeks and was doing well with no specific complaints .
pathology reports revealed the foreign body to be synthetic tubing and the pelvic mass to be soft tissue with extensive scarring and acute suppurative inflammation with focal abscess formation .
a 32-year - old white woman presented to the gynecologic emergency room on november 21 , 1995 , complaining of tenderness and swelling of her right lower quadrant for three days . at that time she was four weeks postpartum from a spontaneous vaginal delivery .
her surgical history was significant for a laparoscopy done in september of 1994 in vienna , austria , where a left salpingoophorectomy reportedly was performed for an ovarian cyst .
pelvic examination revealed a normal uterus with a right adnexal mass approximately 8 cm in size , and exquisitely tender to palpation .
abdominopelvic ct scan revealed a 5.5 cm  4 cm  5.3 cm right adnexal mass , inflammatory in nature .
in addition to this , a 4.3 cm  6 cm  3.4 cm mass was superior to the first mass , in the right lower quadrant , and also inflammatory in nature .
the patient was taken to the operating room by the gynecologic service for an exploratory laparotomy .
intraoperatively , a normal left adnexae was found , not consistent with the patient 's history of left salpingoophorectomy . on the right side
there was a large , 10 cm  12 cm inflammatory mass with the appearance of an abscess . clearly above this mass ,
a 3 cm  2 cm portion of synthetic tubing was found enveloped by omentum ( figure 1 ) .
a partial omentectomy and removal of foreign body was performed , along with an excision of the right pelvic abscess and appendectomy .
antibiotics were continued until the patient was afebrile for 48 hours . by postoperative day number five the patient was tolerating a regular diet and ambulating without assistance .
the patient was seen in the postoperative clinic at four weeks and was doing well with no specific complaints .
pathology reports revealed the foreign body to be synthetic tubing and the pelvic mass to be soft tissue with extensive scarring and acute suppurative inflammation with focal abscess formation .
complications from laparoscopy such as bleeding or structural injury can usually be recognized immediately intraoperatively .
what makes this case unusual is the time interval ( 14 months ) and the fact that the patient had an intervening pregnancy .
it is theorized that the device must have been defective and when removing the sleeve thread anchor , probably with the trocar as a whole unit , a portion of it was sheared off and remained intraabdominally .
the presentation of the patient was also atypical in that clinical evidence pointed to appendicitis .
it is unclear whether the pelvic abscess was directly related to the retained foreign body or if there was another etiology .
the authors favor the foreign body as the source since laparotomy revealed normal bowel and absence of the right adnexae in this patient .
it is strongly suspected that the presence of a foreign body associated with the physiologic changes in the postpartum period combined to provide a favorable environment for abscess formation . in the literature ,
both shortand long - term complications exist and precautions to avoid these should be paramount .
although most complications are related to hemorrhage , bowel or genitourinary injury , the rare case of a retained foreign body from laparoscopic equipment must be considered .
the trend to move to one - piece disposable units where the trocar is self - retaining is one step in the direction of both simplification of laparoscopic procedures and prevention of postoperative complications .
 background : laparoscopy is widely used as a tool in many clinical situations allowing for diagnosis and/or surgical management in a minimally invasive fashion . 
 most laparoscopic cases are ambulatory and allow patients to recover quickly . 
 nonetheless , attention to surgical technique is paramount to avoid both short and long term complications.case:a 32-year - old woman had a laparoscopy and a reported left salpingoophorectomy for benign disease of the ovary in september , 1994 . shortly thereafter , in january , 1995 , she was diagnosed with an intrauterine pregnancy and delivered in october of 1995 by spontaneous vaginal delivery . 
 the pregnancy and delivery were both uncomplicated . 
 the patient presented four weeks postpartum with clinical suspicion of appendicitis . 
 however , at the time of laparotomy , the patient was found to have a retained foreign body from her prior laparoscopy in the right lower quadrant with a pelvic abscess and evidence of prior right salpingoophorectomy . 
 the appendix appeared grossly normal.conclusion:laparoscopy is a safe , effective modality for various surgical and gynecologic conditions . 
 although laparoscopy is usually done on an outpatient basis , complications can manifest several weeks or months later . 
 this case illustrates and reminds us of the importance of adherence to surgical laparoscopic principles . 
 these include direct visualization when removing equipment and a complete count of surgical instrumentation to confirm the integrity of such at the end of each procedure . 
Background:
Case:
Conclusion:
INTRODUCTION
Case Report:
DISCUSSION