Retained surgical sponge or gossypiboma of the breast

Gossypiboma (retained surgical sponge) induces septic shock after previous breast surgery: A case report

Foreign body granuloma caused by retained surgical sponge is also called gossypiboma or textiloma, is mostly described in the abdominal cavity, with only a very few cases of retained surgical sponges located in breasts. A 48-year-old female came to our emergency department due to shortness of breath with consciousness disturbance. Sixteen years previously, she had gone through modified radical mastectomy. Eight years later, she received breast reconstruction. At emergency department, her hemodynamic status was unstable. Besides, there was one mass lesion with abscess in the right axillary region, and percutaneous abscess drainage was performed. She was sent to the medical intensive care unit for further care of septic shock. Because her symptoms and signs did not improve, we decided to perform fasciectomy and surprisingly found one retained surgical sponge in her breast. After the operation, she recovered well and the wound was stable. Due to limited literature available, we present a case of gossypiboma in the breast with a clinical manifestation of septic shock.

Migrating gossypiboma mimicking aspergilloma twenty years after mediastinal surgery

A gossypiboma refers to a surgical sponge or gauze accidentally retained inside a patient during a procedure. It is more commonly encountered after abdominal surgeries. When seen in the thorax, it is usually located within the pleural cavity. We report a case of a 42-year old woman who was found to have a gossypiboma mimicking a simple aspergilloma twenty years after a left thoracotomy. The surgical gauze identified on a CT-scan of her chest appears to have migrated into her lung airways.

Ocular Gossypiboma: Ultrasound B-Scan Assessment of Retained Surgical Sponge After Ahmed Valve Surgery: A Case Report

PURPOSE OF THE STUDY

To present the first documented case of an ocular gossypiboma (retained foreign body) of a mitomycin-C-soaked sponge confirmed echographically using diagnostic ultrasound B-scan after Ahmed valve surgery.

PATIENTS AND METHODS

A patient who underwent phacoemulsification with Ahmed valve implantation surgery had a retained Weck-Cels sponge soaked with mitomycin-C. With the use of ocular ultrasound B-scan, the retained sponge was localized and a second procedure was performed to explant it.

CONCLUSION

In cases of ocular gossypiboma the use of ultrasound modalities can be a valuable tool especially because B-scan access is common and can be cost-effective.

Breast Textiloma: An unending medico-legal issue about a case report

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Forgetting sponges in the breast after surgery is uncommon and may mimic a recurrent tumor after years.

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Medico-legal implications are heavy which jeopardize the reputation of the surgeon.

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The patient was not informed about the real diagnosis because of fear of litigation.

Introduction

Textiloma is a mass composed of retained surgical textile foreign body. It is a rare iatrogenic complication that can engage the doctor’s responsibility. The aim of this manuscript is to report an unusual case of breast Textiloma mimicking a recurrent tumor and to highlight its medico-legal implications.

Presentation of case

A 47-year-old lady, without past medical history, was diagnosed with a breast infiltring intraductal carcinoma. She was treated with mastectomy. Four years later, the patient consulted her surgeon for a subcutaneous mass in the operative site. Both medical and radiological investigations concluded to recurrent tumor. Histological examination confirmed the diagnosis of Textiloma.

Discussion

Retained foreign bodies in the operative site are infrequent but serious iatrogenic complications. Clinical manifestations of Textiloma are variable and non-specific. It should be suspected in any postoperative case with unresolved or unusual problems. It can mimic other conditions such as tumor. Textiloma is a frequently injurious situation that can lead to medico-legal implications. It is considered to be a sample of medical negligence that involves the surgeon responsibility.

Conclusion

Textiloma is a preventable condition and it can be avoidable by maintaining standard recommendations.

[Intestinal occlusion secondary to a retained surgical item]

BACKGROUND

Retained surgical items after a surgical procedure is a real, existing, and preventable problem that affects the safety of the surgical patient. Its incidence is not exactly known due to under-reporting of occurrence, due to the potential risk of lawsuits.

CLINICAL CASE

A 31 year-old women that had an elective caesarean, apparently without complications. In the immediate post-operative period, clinical features appeared that were compatible with intestinal obstruction, such as inability to channel gas, bloating, abdominal pain and vigorous peristalsis. The diagnosis is made by the recent history of abdominal-pelvic surgery and the finding of a foreign body on a simple x-ray of the abdomen. The patient was operated upon, with a satisfactory outcome, and was discharged 5 days later.

CONCLUSION

A retained surgical instrument is an under-reported event that represents a medical-legal problem, leading to various complications, including death if it is not diagnosed and treated early. It is important to know the risk factors and adopt a culture of prevention through perioperative monitoring of equipment and instruments used during the surgical act.

Tumefactive intramural gossypiboma of the urinary bladder mimicking an invasive adnexal malignancy

A surgical swab retained in the body after surgery is known as ‘Gossypiboma’. The purpose of this report is to highlight an intramural vesical gossypiboma mimicking an invasive adnexal malignancy. A 28-year-old multiparous, with open-tubal ligation three years ago, presented with painless hematuria and a nontender mass on vaginal examination. USG suggested ‘pelvic endometriosis’ infiltrating into the bladder and cystoscopy showed no intraluminal extension of the mass. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) misdiagnosed it as invasive malignancy of the fallopian tube. Exploratory laparotomy found it to be an intramural vesical gossypiboma. A pelvic gossypiboma infiltrating into the wall of the urinary bladder may easily be misinterpreted as an invasive pelvic malignancy on imaging and may make one consider unwarranted radical surgery.

Textiloma formation post endovascular repair of abdominal aortic aneurysm

We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient complained of claudication on the left side associated with persistent pain, rigid swelling on the left groin area, and occasional febrile episodes within the last month. Ultrasonography showed fluid collection, and needle aspiration gained pus. It was thought to be local postsurgical infection, and the patient got antibiotics, but he did worse. One month later, computed tomography revealed focal left common femoral artery (CFA) stenosis, edematous appearance of subcutaneous soft tissue in the left groin area, and anterior displacement of the ipsilateral CFA in relation to the right side. Surgical exploration of the region revealed retained, uncapsuled, and partially destroyed surgical gauze, lying just behind the left CFA, which was removed.

Imaging of gossypibomas: pictorial review

OBJECTIVE

Textiloma and gossypiboma are terms used to describe a mass of cotton matrix that is left behind in a body cavity during an operation. This is an uncommon surgical complication. Gossypibomas are most frequently discovered in the abdomen. Such foreign bodies can often mimic tumors or abscesses clinically or radiologically; however, they are rarely reported because of the medicolegal implications. The manifestations and complications of gossypibomas are so variable that diagnosis is difficult and patient morbidity is significant.

CONCLUSION

This article discusses the clinical manifestations, pathophysiologic aspects, and most important complications related to gossypibomas; presents the classic imaging features of gossypibomas using a multitechnique approach; and shows some of the typical and atypical sites of gossypibomas.

Gossypiboma of the breast: imaging findings

We report a case of retained surgical sponge in the breast with its sonographic and magnetic resonance (MR) imaging findings. Striped and spotted low signal intensity structures seen within the lesion on T2 weighted MR imaging was characteristic. Sonographic examination also was helpful with the appearance of strong posterior acoustic shadowing at the lesion. It is extremely rare, to see a gossypiboma in the breast. A high degree of suspicion and imaging findings are very important for the diagnosis.

Retained surgical swab following breast augmentation: a rare cause of a breast mass

Retained surgical swab or sponge following surgery is an uncommon finding seen most commonly following abdominal and pelvic procedures. Reports of such lesions in the breast are particularly rare with only two previously published cases. We report here the first case of a retained swab following breast augmentation where unique diagnostic problems are encountered because of the presence of implants. This case shows that a retained swab should be considered in the differential diagnosis of any postoperative breast mass and highlights that ignoring the fundamental principles of any surgical procedure can cause serious complications.

Gauzoma mimicking siliconoma after breast augmentation surgery

Gauzoma is a rare iatrogenic mass caused by the retention of gauze fibers during surgery. This intraoperative complication represents a diagnostic problem for radiologists besides being a medicolegal problem for surgeons. We present a patient in whom a retained surgical sponge after breast augmentation surgery mimicked a siliconoma and discuss imaging appearance and differential diagnosis.

[Radiological diagnostics for iatrogenic retained foreign bodies after surgery]

Retention of surgical sponges is rare. They cause either an aseptic reaction without significant symptoms or an exudative reaction which results in early but non-specific symptoms. Even if there are no studies which compare the diagnostic accuracy of the different imaging modalities, CT seems to be the most promising tool to diagnose foreign bodies. However, apart from radio-paque markers there are no specific signs for the existence of surgical sponges in CT. Therefore, an experienced radiologist is needed to differentiate foreign bodies from morphologically quite similar differential diagnoses such as abscess and haematoma.

Medical and legal evaluations of the retained foreign bodies in Turkey

Like other countries, the physicians accusation that might be right or wrong, have increased nowadays in Turkey. Even all precautions are taken in the operation theatre, there are still some cases in which foreign bodies are retained in the abdominal cavity. It is not likely for the cases of retained foreign bodies in the abdominal cavity to be considered as an acceptable complication. Therefore, the surgeon must keep in mind that in such situations they are going to be judged as faulty both in the civil courts and in the courts of first instance. In this study incidences, causes and legal outcomes of the foreign bodies that are left behind in the abdominal cavity in Turkey are discussed.

Calcified reticulate rind sign: A characteristic feature of gossypiboma on computed tomography

We herein report a gossypiboma resulting from a retained surgical swab, which had been left in peritoneum for 20 years after appendectomy. CT revealed a cystic mass with a calcified reticulate rind. Subsequent surgery and pathological examination showed a gossypiboma. A simple experiment, using a barium-soaked surgical swab demonstrating similar CT appearance, supported our postulation that calcium deposition on the reticulated fibers of a surgical swab could generate such a characteristic “calcified reticulate rind” sign. We believe that identification of this CT sign facilitates the diagnosis of gossypibomas.