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Varlas VN, Bors RG, Mastalier B, Balescu I, Bacalbasa N, Cirstoiu MM. Gossypiboma, the Hidden Enemy of an Emergency Cesarean Hysterectomy-Case Report and Review of the Literature. J Clin Med 2023; 12:5353. [PMID: 37629395 PMCID: PMC10455589 DOI: 10.3390/jcm12165353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Gossypiboma or textiloma is a rare medical situation that can complicate the favorable evolution of a surgical case, with repercussions for the patient's prognosis. The diagnosis can be difficult due to various clinical symptoms, the time elapsed since the surgical intervention, and the imaging often not being precise in detecting textilomas. Due to the medicolegal implications, the reporting of this event is inconsistent. We present a rare case of a 28-year-old woman who presented with vague pain in the left iliac fossa 11 months after an emergency cesarean hysterectomy was performed. The preoperative imaging examination identified the presence of a subhepatic mass with dimensions of 10 × 8 cm2 and another formation in the right iliac fossa with dimensions of 11 × 9 cm2. Exploratory laparotomy found the presence of a large subhepatic gossypiboma, intimately adherent to the hepatic angle of the colon and omentum and a second one adherent to the sigmoid colon, small intestine, and parietal peritoneum. The particularity of this case is given by the simultaneous presence of two textilomas with inconclusive evolution, which can make the differential diagnosis difficult to achieve. For a better assessment of the risk of occurrence of this pathology and the identification of a correct prevention strategy, we performed an extensive search and a review of all the articles published in the PubMed database, identifying 57 articles. In conclusion, emergency surgery increases the risk of this complication, and, as a result, prevention can be achieved by following existing protocols in the operating room.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania;
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania;
| | - Bogdan Mastalier
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania
- General Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, Ponderas Academic Hospital, 021188 Bucharest, Romania;
| | - Nicolae Bacalbasa
- Department of Visceral Surgery, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Monica-Mihaela Cirstoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Kyle E. Preventing Unintentionally Retained Surgical Items. AORN J 2023; 117:192-199. [PMID: 36825909 DOI: 10.1002/aorn.13885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 02/25/2023]
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3
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Intra-abdominal Gossypibomas: Clinical Manifestations, Risk Factors and Prevention. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mejri A, Arfaoui K, Aloui B, Yaakoubi J. Gossypiboma: the failure of a successful intervention. Pan Afr Med J 2020; 36:335. [PMID: 33193988 PMCID: PMC7603822 DOI: 10.11604/pamj.2020.36.335.25464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
If successful surgery is the primary quest of any surgeon, unintentionally leaving behind surgical items in the operative field remains his most feared obsession. This rare but dramatic accident can lead to potentially fatal complications and turn both lives of the surgeon and the patient upside down. We present the case of a 29-year-old female patient who presented to the ER with three days history of severe diffuse abdominal pain associated with fever, biological inflammatory syndrome and well-tolerated iron deficiency anaemia. She had no past medical history except for a lower segment cesarean section 5 months ago. Abdominal MRI allowed the diagnosis of two gossypibomas responsible for two intra-abdominal collections. An emergency laparotomy allowed the removal of these foreign bodies and the management of their serious complications of intestinal perforation by the construction of a double intestinal stoma. The patient made a post-operative uneventful recovery. This observation emphasizes the need to raise the practitioner´s awareness about this differential diagnosis in every case of any poorly localized abdominal pain occurring after surgery.
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Affiliation(s)
- Atef Mejri
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Khaoula Arfaoui
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Badreddine Aloui
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Jasser Yaakoubi
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
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de la Fuente López E, Muñoz García Á, Santos Del Blanco L, Fraile Marinero JC, Pérez Turiel J. Automatic gauze tracking in laparoscopic surgery using image texture analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 190:105378. [PMID: 32045796 DOI: 10.1016/j.cmpb.2020.105378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Inadvertent retained surgical gauzes are an infrequent medical error but can have devastating consequences in the patient health and in the surgeon professional reputation. This problem seems easily preventable implementing standardized protocols for counting but due to human errors it still persists in surgery. The omnipresence of gauzes, their small size, and their similar appearance with tissues when they are soaked in blood make this error eradication really complex. In order to reduce the risk of accidental retention of surgical sponges in laparoscopy operations, in this paper we present an image processing system that tracks the gauzes on the video captured by the endoscope. METHODS The proposed image processing application detects the presence of gauzes in the video images using texture analysis techniques. The process starts dividing the video frames into square blocks and each of these blocks is analyzed to determine whether it is similar to the gauze pattern. The video processing algorithm has been tested in a laparoscopic simulator under different conditions: with clean, slightly stained and soaked in blood gauzes as well as against different biological background tissues. Several methods, including different Local Binary Patterns (LBP) techniques and a convolutional neural network (CNN), have been analyzed in order to achieve a reliable detection in real time. RESULTS The proposed LBP algorithm classifies the individual blocks in the image with 98% precision and 94% sensitivity which is sufficient to make a robust detection of any gauze that appears in the endoscopic video even if it is stained or soaked in blood. The results provided by the CNN are superior with 100% precision and 97% sensitivity, but due to the high computational demand, real-time video processing is not attainable in this case with standard hardware. CONCLUSIONS The algorithm presented in this paper is a valuable tool to avoid the retention of surgical gauzes not only because of its reliability but also because it processes the video transparently and unattended, without the need for additional manipulation of special equipment in the operating room.
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Affiliation(s)
- Eusebio de la Fuente López
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Álvaro Muñoz García
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Lidia Santos Del Blanco
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Juan Carlos Fraile Marinero
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Javier Pérez Turiel
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
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Letter to the Editor: Gossypibomas and Bariatric Surgery, an Issue We Can't Forget. Obes Surg 2020; 30:3219-3221. [PMID: 32347521 DOI: 10.1007/s11695-020-04634-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lee SZ, Ooi ML, Jervis-Bardy J, Chong S. Delayed presentation of a semicentennial gossypiboma in the soft palate and posterior nasopharyngeal wall. ANZ J Surg 2020; 90:2366-2368. [PMID: 32065710 DOI: 10.1111/ans.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/08/2020] [Accepted: 01/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shawn Zhenhui Lee
- Division of Surgery, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Mian Li Ooi
- Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, Adelaide, South Australia, Australia
| | - Jake Jervis-Bardy
- Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, Adelaide, South Australia, Australia
| | - Sheldon Chong
- Division of Surgery, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, Adelaide, South Australia, Australia
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Butt UI, Shafiq AB, Umar M, Ashfaq M, Ayyaz M. Transmigration and spontaneous passage of a gossypiboma documented on contrast study. Ann Med Surg (Lond) 2019; 38:42-44. [PMID: 30655970 PMCID: PMC6329201 DOI: 10.1016/j.amsu.2018.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 11/26/2022] Open
Abstract
Gossypiboma or textiloma is a rare but very unfortunate complication of surgery. It refers to a retained foreign body usually forgotten within the abdominal cavity at the end of an operation. It may be a surgical sponge, gauze pad or other form of textile. We present the case of a middle aged lady who following cholecystectomy had a forgotten gauze which underwent transmural migration and was later expelled via the rectum demonstrated by radiological studies. Gossypiboma. Transvisceral migration. Spontaneous expulsion. Radiological study.
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Affiliation(s)
| | | | - Muhammad Umar
- Surgical Unit 2, Services Hospital, Lahore, Pakistan
| | - Maryam Ashfaq
- Surgical Unit 2, Services Hospital, Lahore, Pakistan
| | - Mahmood Ayyaz
- Surgical Unit 2, Services Hospital, Lahore, Pakistan
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Pole G, Thomas B. A Pictorial Review of the Many Faces of Gossypiboma - Observations in 6 Cases. Pol J Radiol 2017; 82:418-421. [PMID: 28819464 PMCID: PMC5549714 DOI: 10.12659/pjr.900745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/13/2016] [Indexed: 01/22/2023] Open
Abstract
Gossypiboma or textiloma is the result of a foreign-body reaction to extraneous material, usually a surgical sponge that was accidentally retained within the body. The diagnosis of a retained surgical sponge is often delayed due to its infrequent occurrence and protean appearances. The purpose of this pictorial review is to define the common sonographic and CT features of gossypiboma. A retrospective review of sonographic and CT images of 6 surgically proven cases of retained surgical sponges was undertaken.
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Affiliation(s)
- Gayatri Pole
- Department of Radiology, Luton and Dunstable University Hospital, Luton, U.K
| | - Bright Thomas
- Department of Radiology, Luton and Dunstable University Hospital, Luton, U.K
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De U, Dutta M, Chattopadhyay P. Gossypiboma. Clin Case Rep 2016; 4:838-9. [PMID: 27525097 PMCID: PMC4974441 DOI: 10.1002/ccr3.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/19/2016] [Accepted: 05/31/2016] [Indexed: 12/01/2022] Open
Abstract
Gossypiboma is a dreadful complication and nightmare for a surgeon. It might cost the patient his life and the surgeon his reputation. It is a preventable condition and additional safeguard measures should be sought and implemented to prevent against human error.
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Affiliation(s)
- Utpal De
- Department of Surgery B S Medical College Hospital Bankura West Bengal India
| | - Manas Dutta
- Department of Surgery Medical College Hospital Kolkata West Bengal India
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