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Andronic D, Lupaşcu C, Târcoveanu E, Georgescu S. [Gossypiboma--retained textile foreign body]. Chirurgia (Bucur) 2010; 105:767-777. [PMID: 21355175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED INTRODUCTION, HISTORY: Increasing complexity of modem surgery is accompanied by the emergence of very different possibility of errors; one of the oldest and most obvious errors is the foreign body forgotten inside the patient. Surgeons worldwide have reported this incident since the first record by Wilson in 1884. DEFINITIONS Over time, different terms have been used for retained textile foreign body (RTFB), with various etymologies, sometimes controversial: gossypiboma is the latest in this line. EPIDEMIOLOGY Various studies indicate the incidence of RTFB in range of 1:833-1:32.672; this expresses the difficulty to determine precisely due to complex causes. In our unit the incidence is 1:15.047. RTFB occur after operations on any cavity or organ (operations on the abdomen 56%, pelvis 18%, thorax 11%, orthopedic, neurosurgical, cardiovascular, etc.), at all ages and both sexes. DIAGNOSIS IS VARIABLE: from a loud postoperative evolution, with fever, suppuration of the wound, fistula tracks, spontaneous erosion into various hollow organs to a long asymptomatic period. Imaging diagnosis is difficult and requires RTFB inclusion in the differential diagnosis of patients with a history of surgery. Treatment involves a patient's informed consent and an adjustment to a case: removal of RTFB and individualized treatment of any associated injuries (abscess, fistulas, adhesions, remaining cavity, foci of bone lysis) or just monitoring. PREVENTION From the theory of "bad apple" (mistake of an incompetent doctor) we moved forward to address systems that often contain latent errors whose summation results in the unfortunate incident. Various national authorities have issued regulations to prevent RTFB, based on counting compresses, intra-/postoperative radiography, marking compresses with two-dimensional matrix label or radio frequency identification. CONCLUSIONS RTFB, no matter how exotic we name it, remains an unfortunate incident with serious consequences for patient and surgeon alike. The introduction of new technologies can help create a safer environment in the operating room, but beyond that the human factor implies the presence of variables difficult or impossible to control.
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Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J, Mark DB, Marcet JE, Remzi FH, George VV, Newland K, Corey GR. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 2010; 363:1038-49. [PMID: 20825316 DOI: 10.1056/nejmoa1000837] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal surgery. The gentamicin-collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges. METHODS In a phase 3 trial, we randomly assigned 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites to undergo either the insertion of two gentamicin-collagen sponges above the fascia at the time of surgical closure (the sponge group) or no intervention (the control group). All patients received standard care, including prophylactic systemic antibiotics. The primary end point was surgical-site infection occurring within 60 days after surgery, as adjudicated by a clinical-events classification committee that was unaware of the study-group assignments. RESULTS The incidence of surgical-site infection was higher in the sponge group (90 of 300 patients [30.0%]) than in the control group (63 of 302 patients [20.9%], P=0.01). Superficial surgical-site infection occurred in 20.3% of patients in the sponge group and 13.6% of patients in the control group (P=0.03), and deep surgical-site infection in 8.3% and 6.0% (P=0.26), respectively. Patients in the sponge group were more likely to visit an emergency room or surgeon's office owing to a wound-related sign or symptom (19.7%, vs. 11.0% in the control group; P=0.004) and to be rehospitalized for surgical-site infection (7.0% vs. 4.3%, P=0.15). The frequency of adverse events did not differ significantly between the two groups. CONCLUSIONS Our large, multicenter trial shows that the gentamicin-collagen sponge is not effective at preventing surgical-site infection in patients who undergo colorectal surgery; paradoxically, it appears to result in significantly more surgical-site infections. (Funded by Innocoll Technologies; ClinicalTrials.gov number, NCT00600925.)
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Starr L. Mandatory reporting--a panacea for poor practice? AUSTRALIAN NURSING JOURNAL (JULY 1993) 2010; 18:21. [PMID: 20954477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Courts rejected RIL: did nurses botch sponge count? Baxter v. Ash Samaritan Hospital, LLC, 2008-CA-000541-MR KYCA (1/15/2010)-KY. NURSING LAW'S REGAN REPORT 2010; 51:1. [PMID: 21090541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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de Campos FF, Franco F, Maximiano LF, Martinês JAS, Felipe-Silva AS, Kunitake TA. An iron deficiency anemia of unknown cause: a case report involving gossypiboma. Clinics (Sao Paulo) 2010; 65:555-8. [PMID: 20535375 PMCID: PMC2882551 DOI: 10.1590/s1807-59322010000500014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Can suit succeed after expiration of limitations? Case on point: Walters v. Cleveland Regional Medical Center, 08-0169 (3/12/2010) S.W.3d-TX. NURSING LAW'S REGAN REPORT 2010; 50:2. [PMID: 20499619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kpolugbo J, Alili U, Abubakar M. Intra-abdominal gossypiboma: a report of two cases and a review of literature. THE CENTRAL AFRICAN JOURNAL OF MEDICINE 2010; 56:17-19. [PMID: 23457869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Post operative foreign body in the abdominal cavily, though rare continues to occur in surgical practice. Symptoms may start early with abdominal pain but usually have a varying course, ofter leading 10 the formation of gossypiboma. This is usually a great source of embarrassment to the surgeon and the centre, and of serious detrimental effect to the patient. A case report of a 27-year-old trader with intra-abdominal foreign body is presented to highlig at the similarity in presentation with abdominal lymphoma and the need to explore carefully masses in the abdominal cavity especially in patients who have had surgery in the past. A high index of suspicious is required on the part of the clinician in addition to appropriate radiological and sonologic assessment. Prompt diagnosis and treatment ameliorates the patients suffering and brings them back to life.
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Ivica M, Ledinsky M, Radić B, Savić A, Tomas D, Vidović D, Tomljenović M, Zovak M, Matejcić A, Nevajda B. After 40 years gossypiboma caused spleen abscess. COLLEGIUM ANTROPOLOGICUM 2009; 33:973-975. [PMID: 19860134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a case of spleen abscess cased by foreign body (gossypiboma) after 40 years. After physical examination, laboratory, ultrasonography and CT findings with diagnosis of acute abdomen, 73 years old woman had undergone laparatomy. Operation revealed intraabdominal spleen abscess. Capsulotomy and drainage of the collection was performed before splenectomy. Histological examination showed foreign body material surrounded by chronic inflammation, foreign body-type multinucleated giant cells, extravasated red blood cells and fibroblastic proliferation. From anamnesis we found that woman was operated only once during a life with diagnosis of extrauterine pregnancy, 40 years ago. Spleen abscess caused by gossypiboma after 40 years was never described before. However, diagnosis like this is very well known but rarely published because medical-legal implication. Education, professionalism and cooperation of all persons involved in surgical procedure are very important to prevent accidentally mistakes.
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Le HBQ, Lee S, Malfair D, Munk PL. Imaging features of chest wall gossypiboma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1265-1268. [PMID: 19710227 DOI: 10.7863/jum.2009.28.9.1265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Hakan T, Aydoseli A, Demir K, Aker F. Clinical, pathological and radiological features of paraspinal textiloma: report of two cases and review of the literature. Neurol Neurochir Pol 2009; 43:475-478. [PMID: 20054750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Textiloma is a term used for retained cottonoid or surgical sponge in the operation field. Although they occur mostly after thoracic or abdominal operation, they can also be encountered after surgery of extremities or the spine. There are few reports of spinal cases in which MR and CT imaging findings of textilomas have been described. In this report, two additional cases with MR, CT and pathological features of paraspinal textilomas are described. CT image demonstrated a paraspinal mass simulating a malignant tumour. While T1-weighted MR images showed the masses with low signal intensity, T2-weighted MR images showed heterogeneous masses with low and high signal intensities.
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Smoljanovic T, Bojanic I, Delimar D. Adverse effects of posterior lumbar interbody fusion using rhBMP-2. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:920-3; author reply 924. [PMID: 19352727 PMCID: PMC2899661 DOI: 10.1007/s00586-009-0959-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 03/22/2009] [Indexed: 11/26/2022]
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Regenbogen SE, Greenberg CC, Resch SC, Kollengode A, Cima RR, Zinner MJ, Gawande AA. Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness. Surgery 2009; 145:527-35. [PMID: 19375612 PMCID: PMC2725304 DOI: 10.1016/j.surg.2009.01.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. METHODS Key model parameters were obtained from field observations during a randomized-controlled BCS trial (n = 298), an observational study of RSS (n = 191,168), and clinical experience with BCS (n approximately 60,000). Because no comparable data exist for RF, we modeled its performance under 2 alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision maker's perspective. RESULTS Standard counting detects 82% of RSS. Bar coding prevents > or =97.5% for an additional $95,000 per RSS averted. If RF were as effective as bar coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal and selective x-rays for high-risk operations are more costly, but less effective than BCS-$1.1 to 1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost. CONCLUSION Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly "never events." Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.
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Arcas Bellas JJ, Gracia Martínez JL, Cuarental García A, Fajardo Pérez MI. [Intrathoracic gossypiboma: a case report]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:54-56. [PMID: 19284133 DOI: 10.1016/s0034-9356(09)70325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Kansakar R, Thapa P, Adhikari S. Intraluminal migration of Gossypiboma without intestinal obstruction for fourteen years. JNMA J Nepal Med Assoc 2008; 47:136-138. [PMID: 19079379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
A 55 years lady presented with dull aching right upper abdominal pain with intermittent episodes of diarrhea following cholecystectomy which she underwent fourteen years back. Ultrasound and computed tomography findings were suggestive of foreign body in right subhepatic space. Exploratory laparotomy revealed circumvented loop of ileum with intra luminal mass sized 5 x 10 cm, resection anastomosis of the segment of ileum was performed. When opened it contained a surgical sponge with no external communication but an internal fistulous tract was present between the proximal and distal loops beyond the mass. Though intraluminal migration of retained surgical sponge has often been reported, complete intraluminal migration without features of obstruction or external opening is rarely seen.
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Lourenco SC, Baptista A, Pacheco H, Malhado J. A misplaced surgical towel - a rare cause of fever of unknown origin. Eur J Intern Med 2008; 19:377-8. [PMID: 18549946 DOI: 10.1016/j.ejim.2007.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 07/14/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
Abstract
Retained surgical towels, usually called gossypiboma, are rare, but can cause important morbidity and mortality. Usually they are discovered during the first few days after surgery, but may remain undetected for many years. Bowel obstruction, perforation, pseudotumor or peritonitis are most often the clinical presentation, but in some cases only constitutional symptoms prevail. Diagnosis can be difficult, mostly because of low clinical suspicion. We report a case of a woman who presented with fever and weight loss three and half years after an abdominal surgery. After an extensive workup, a gossypiboma was finally discovered and removed, leading to a complete cure.
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Mahalik SK, Gupta SK, Khanna AK. Gossypiboma: intramural and transmural migration causing small bowel obstruction. ANZ J Surg 2008; 78:417-8. [PMID: 18380752 DOI: 10.1111/j.1445-2197.2008.04496.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Haegeman S, Maleux G, Heye S, Daenens K. Textiloma complicated by abscess-formation, three years after surgical repair of abdominal aortic aneurysm. JBR-BTR : ORGANE DE LA SOCIETE ROYALE BELGE DE RADIOLOGIE (SRBR) = ORGAAN VAN DE KONINKLIJKE BELGISCHE VERENIGING VOOR RADIOLOGIE (KBVR) 2008; 91:51-53. [PMID: 18549148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This report deals with a late complication of open surgery for inflammatory abdominal aortic aneurysm. A surgical sponge was retained and three years later, the patient presented with acute onset of back pain. Radiological evaluation by means of abdominal plain film and CT-scan, respectively revealed metallic wires projecting in the left hypochondrium and a rounded hypodense mass-lesion located retroperitoneally above the left kidney, containing the metallic wires and presenting with a contrast-enhancing peripheral rim, corresponding to abscess-formation around the retained sponge. The patient was treated by surgical retrieval of the sponge and drainage of the abscess. The aim of this report is to highlight the importance of both abdominal plain film and CT-scan in the detection of a potential textiloma after aortic surgery, even in case of late clinical presentation.
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Erdil A, Kilciler G, Ates Y, Tuzun A, Gulsen M, Karaeren N, Dagalp K. Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus. Intern Med 2008; 47:613-5. [PMID: 18379146 DOI: 10.2169/internalmedicine.47.0391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 55-year-old hemiplegic woman with percutaneous endoscopic gastrostomy (PEG) was referred to our clinic for upper gastrointestinal system bleeding and for a high level of cholestatic enzymes. She had a medical history of cerebra vascular accident three years previously and cholecystectomy one year previously. We performed gastroscopy and saw a retained surgical sponge in the bulbus. After removal of the gossypiboma, endoscopic sclerotherapy was performed for the bleeding area at the bulbus. After the procedure, the upper gastrointestinal bleeding stopped and the high level of cholestatic enzymes returned to normal.
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Abstract
Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.
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Araki K, Hirakawa N, Kosugi T, Higashimoto I, Kakiuchi Y, Nakashima M. Iodoform intoxication; a case report of prolonged consciousness disturbance in a patient with a high plasma iodine level. FUKUOKA IGAKU ZASSHI = HUKUOKA ACTA MEDICA 2007; 98:397-401. [PMID: 18186295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This report describes a case in which a consciousness disturbance was associated with a high plasma iodine level and which improved after the removal of iodoform gauze that had been applied to infected wounds. A 71-year-old male with poorly controlled diabetes underwent a laminectomy for an epidural abscess. On the 6th and 8th postoperative days, he underwent debridement for fasciitis in the both arms and iodoform gauze was applied to the wounds (both arms and lumbar region) at the end of the first debridement and then changed every day. His consciousness then gradually deteriorated after the debridement. His plasma iodine level was measured and was shown to be remarkably high (6,280 microg/dl) 19 days after the laminectomy (13 days after the beginning of iodoform application). His consciousness recovered gradually with a concomitant decrease in the plasma iodine level. Three months after the removal of the iodoform he became almost alert. Caution should be exercised in using iodoform gauze because of the possibility that it could affect consciousness.
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Brylka D, Abrams R, Karlman R, Besinger RE, Dudiak CM. Sonographic detection of an unsuspected intra-abdominal surgical sponge in a pregnant patient. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1445-8. [PMID: 17901148 DOI: 10.7863/jum.2007.26.10.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Zissin R, Osadchy A, Gayer G. Abdominal CT findings of delayed postoperative complications. Can Assoc Radiol J 2007; 58:200-211. [PMID: 18186431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Nieves L, Schnatz PF, Sahakyan M, Sorosky JI. A retained surgical sponge presenting as chronic pelvic pain. CONNECTICUT MEDICINE 2007; 71:461-3. [PMID: 17902383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Gossypiboma, the term for a retained sponge, is an underestimated occurrence related to gynecologic surgery. The postoperative presentation can be acute or subacute with symptoms that include pelvic pain. CASE A 39-year-old G7P3043 female presented with chronic pelvic pain. Her only past surgeries were 16 and 21 years prior. After failing to respond to conservative options, she was taken to the operating room for a hysterectomy and possible salpingoophorectomy. During the surgery, a retained sponge was found and removed. Postoperatively, the pain resolved completely. CONCLUSION Although gossypiboma is an uncommon cause of chronic pelvic pain, patients can present years later with minimal complications other than discomfort. Accurate sponge and instrument counts, along with radiologic evaluation when a discrepancy is found, can be helpful. Newer technologies are also being developed to help avoid this complication.
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Parolari A, Fusari M, Biglioli P. Paraplegia because of hemostatic agents in the costovertebral space: this occurs even in thoracic aorta surgery. J Cardiothorac Vasc Anesth 2007; 21:624-5. [PMID: 17678804 DOI: 10.1053/j.jvca.2006.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Indexed: 11/11/2022]
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