Gossypiboma: retained surgical sponge after a gynecologic procedure

Gossypiboma mistaken for a hydatid cyst: case report

Although considered a rare complication, gossypiboma continues to be a clinically important and probably more frequently encountered than reported situation. This study aimed to report a case of gossypiboma that was mistaken for a hydatid cyst in the preoperative evaluation. A 34-year-old male patient with a history of Nissen Fundoplication presented with a large mass palpable in the epigastrium and both the left upper and lower quadrants of the abdomen. Computerized tomography was reported to show a 20x18 cm cystic mass with a collapsed germinative membrane inside it. Laparotomy, which was performed with a suggested diagnosis of type 3 hydatid cyst, revealed that the mass was caused by a 30x30 cm surgical abdominal compress. We believe gossypiboma should be kept in mind in the differential diagnosis of abdominal hydatid cysts in the presence of a former abdominal operation, especially when the result of indirect hemagglutination test is negative.

Gossypiboma masquerading as nephrocutaneous fistula

Nephrocutaneous fistula is a rare complication of surgical procedures involving the kidney. Fistula formation is also a complication seen in gossypiboma. We present the case of a patient who was initially suspected to have nephrocutaneous fistula after open pyelolithotomy. Later while undergoing open resection of fistula, he was found to have a retained surgical sponge (gossypiboma) near the lower pole of kidney. Gossypiboma is a term used for mass formed around a surgical sponge accidentally left in the body. It is most of the times not diagnosed by radiological imaging and thus results in unnecessary investigations to rule out other causes for the patient's symptoms. Having a high index of suspicion may lead to an earlier diagnosis. But the prevention of gossypiboma is of the utmost importance. A meticulous approach while operating by the surgeon and operating rooms staff is very important in doing so.

Intrapericardial gossypiboma: Rare cause of intrathoracic mass

INTRODUCTION

Gossypiboma is a retained surgical sponge inside our body after surgical intervention. It is most commonly found in abdominal cavity. Its occurrence in thoracic cavity as intrapericardial gossypiboma is extremely rare.

PRESENTATION OF CASE

We present a 25 year old male with complaint of chest pain for 1 year. He had a history of total correction of Tetralogy of fallot 14 years back, at another hospital. On clinical examination and investigations including contrast enhanced computed tomography (CECT) of thorax; diagnosis of right anterior mediastinal mass of germ cell tumor was made and planned for thoracotomy. On exploration, the gauze piece of 31 cm was removed from the pericardial mass and a final diagnosis of gossypiboma was made.

DISCUSSION

Although gossypibomas are commonly reported in abdominal and pelvic surgery but a prolonged operative time, untrained staff, poor communication in sponge count may favour the occurrence in thoracic cavity. A patient with intrathoracic gossypiboma usually presents with chest pain, dyspnoea, thoracic mass or fever. CECT and Magnetic resonance Imaging (MRI) are useful imaging modality in such cases. Surgical exploration with histopathological examination confirms the diagnosis of gossypiboma.

CONCLUSION

In a postoperative patient who presents with chest pain and intrathoracic mass, gossypiboma should be a differential diagnosis even it is rare to occur in thorax.

Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review

Background

Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed.

Case presentation

A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful.

We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients.

Conclusion

Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention could be considered for intractable cases in which endoscopic extraction failed.

The recurring problem of retained swabs and instruments

Patient safety is one of the most pressing challenges in health care. The promotion of safety requires that all those involved in healthcare realise that the potential for errors exists, and that teamwork and communication are essential for preventing errors. Incidents compromising patient safety, such as unintended retention of swabs or instruments, are regarded as 'never events'. These incidents are considered 'unacceptable and eminently preventable', as pointed out by the Department of Health 'never events list' 2012/2013. One estimate says that one case of a retained item occurs at least once a year in a major hospital where 8000 to 18,000 major cases are carried out each year. All healthcare organisations should take appropriate measures to prevent retention of foreign bodies by consistent application of reliable and standardised processes of care. In this review, we explore the risks and complications associated with retained swabs and instruments, and different ways to prevent such risks to patients.

Gossypiboma, a rare cause of acute abdomen: A case report and review of literature

Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Inadvertent retention of a foreign body in the abdomen often requires another surgery. This increases morbidity and mortality of the patient, cost of treatment, and medicolegal problems. We are reporting case of a 45-year-old woman who was referred from periphery with acute pain in abdomen. She had a surgical history of abdominal hysterectomy 3 years back, performed at another hospital. On clinical examination and investigation, twisted ovarian cyst was suspected. That is a cystic mass further confirmed by abdominal computerized tomography (CT). During laparotomy, the cyst wall was opened incidentally which lead to the drainage of a large amount of dense pus. In between pus, there was found retained surgical gauze that confirmed the diagnosis of gossypiboma.

Gossypibomas mimicking a splenic hydatid cyst and ileal tumor : a case report and literature review

BACKGROUND

Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical procedure. Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be a diagnostic dilemma with associated medico-legal implications, and is usually discovered during the first few days after surgery; however, it may remain undetected for many years.

METHODS

We present a gossypiboma case immigrating to small intestine, as well as a literature review of studies published in the English language on intraluminal migration of gossypiboma, accessed through PubMed and Google Scholar databases.

RESULTS

Case of a 51-year-old man who was admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal trauma 8 years previously, and surgery had been performed at another hospital. The physical examination revealed muscular guarding and rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass were suspected based on results of abdominal computed tomography. Therefore, a laparotomy was performed. Segmental ileal resection, end-to-end anastomosis, and splenectomy were performed. The final diagnosis was gossypiboma in both the spleen and ileum. We performed a systemic review of the English-language literature between 2000 and 2010 in PubMed and Google Scholar, and we found 45 cases of transmural migration of surgical sponges following abdominal surgery. Three cases in which the gossypiboma was located in the spleen are also discussed.

CONCLUSION

Gossypiboma should be considered as a differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable mass.