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Elamin HOA, Masoud MS, Mohamed Ali KSE, Fadl HAO, Hamza AHA, Basheer HAM, Alfaraja M. Unintentionally retained lap sponge mimicking an ovarian cyst two years after Caesarean section in a 37-year old patient: case report of a rare "never event" in Sudan. Patient Saf Surg 2024; 18:26. [PMID: 39152454 PMCID: PMC11328475 DOI: 10.1186/s13037-024-00407-x] [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: 04/07/2024] [Accepted: 07/02/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION This case report reports an unusual occurrence of gossypiboma, which refers to the accidental retention of surgical materials like sponges in the peritoneal cavity. The term is derived from "gossypium" (cotton) and "boma" (place of concealment). Its incidence varies with surgical type, posing diagnostic challenges due to nonspecific symptoms and equivocal imaging. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation. CASE PRESENTATION A 37-year-old woman with ten previous pregnancies and an emergent caesarean section presented with abdominal pain. Examination and ultrasound suggested an ovarian cyst. During surgery, a 10 × 10 cm gauze-filled mass adherent to the ovary and jejunum was found. Postoperatively, she recovered well with no complications. The patient was treated with intravenous fluids and antibiotics for five days post-surgery and recovered without any complications. She was discharged from the hospital five days after the procedure. CONCLUSION To the best of our knowledge, this is the first reported case of gossypiboma in Sudan in 2024, highlighting diagnostic challenges and the need for preventive protocols. Root cause analysis of accidents, enhanced training, application of advanced technologies and a collaborative culture in the operating room can prevent the occurrence of such incidents. This case underscores the importance of meticulous surgical protocols and continuous improvement in safety measures to prevent retained surgical items, ensuring patient safety and optimal outcomes.
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Affiliation(s)
| | - M Sayed Masoud
- Faculty of Medicine and Health Sciences, University of Bakht Alruda, Ad Duwaym, Sudan
| | | | - Hiba Awadelkareem Osman Fadl
- Department of Haematology, Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
- Senior Medical Laboratory Specialist, Saudi Commission for Health Specialties (SCFHS), Makkah, Kingdom of Saudi Arabia
| | - Abdelrahman Hamza Abdelmoneim Hamza
- Clinical Immunology Resident, Medical Specialization Board (SMSB), Khartoum, Sudan
- Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
| | | | - Mohamed Alfaraja
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Bakht Alruda, Ad Duwaym, Sudan
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Haleem S, Mahmoud MH, Kainth GS, Botchu R, Hassan MF, Rehousek P. A perioperative overview of a retained surgical swab in spinal surgery: Case report and prevention protocol. J Perioper Pract 2024; 34:101-105. [PMID: 37125625 DOI: 10.1177/17504589231163685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Retained wound swabs although classified as a 'never event' and well documented in many surgical specialties are uncommon in spinal surgery. The aim of this article is to highlight the perioperative circumstances of an incident of a retained surgical swab and present a prevention protocol, in an attempt to eliminate its incidence. CASE REPORT The perioperative management of a 53-year-old male undergoing spinal surgery in whom a surgical swab was retained is reported. In addition to existing safety procedures such as the World Health Organization checklist, a Retained Surgical Swab-Prevention Protocol was implemented in our hospital and is presented to eliminate the occurrence of this 'never event' occurring again. CONCLUSION Retained surgical swabs or instruments are rare in spinal surgery occurring mostly in the lumbar spine, during emergency and prolonged procedures in patients with high body mass index. Maintaining a high index of suspicion and utilising a prevention protocol will prevent further harm to the patient.
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Syed IA, Rafi K, Wasif Khan HM, Malik AK, Aujla UI. A Cotton Rope in the Colon: A Rare Cause of Chronic Abdominal Pain. ACG Case Rep J 2024; 11:e01251. [PMID: 38234979 PMCID: PMC10793968 DOI: 10.14309/crj.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe this condition. We present a case of a 40-cm-long retained surgical sponge in a 43-year-old woman who presented with unexplained chronic abdominal pain for several years. She had a history of open cholecystectomy, hepaticojejunostomy, and enteroenterostomy. Computed tomography scan revealed a large cotton sponge anchored within the large bowel. Surgical exploration is usually required for the retrieval of gossypiboma. However, it was successfully removed endoscopically using a diathermic needle knife with no immediate complications. The patient was discharged after 48 hours with marked improvement in her abdominal pain. This case emphasizes the emerging role of novel endoscopic interventions, resulting in excellent clinical outcomes, avoiding major surgical interventions, and providing cost-effective benefits.
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Affiliation(s)
- Imran Ali Syed
- Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Center, DHA Phase VI, Lahore, Pakistan
| | - Kashif Rafi
- Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Center, DHA Phase VI, Lahore, Pakistan
| | - Hafiz Muhammad Wasif Khan
- Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Center, DHA Phase VI, Lahore, Pakistan
| | - Ahmad Karim Malik
- Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Center, DHA Phase VI, Lahore, Pakistan
| | - Usman Iqbal Aujla
- Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Center, DHA Phase VI, Lahore, Pakistan
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Min J, Lee S, Kim WJ, Kim SE. A Case Report of Neglected Gossypiboma Causing Abdominal Pain for 20 Years Post-Cesarean Section. J Menopausal Med 2022; 28:139-141. [PMID: 36647278 PMCID: PMC9843038 DOI: 10.6118/jmm.22022] [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: 06/15/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Gossypiboma refers to a mass usually made of cotton (e.g., surgical gauze or sponge) that is accidentally left in a patient's body during surgery. We report the case of a 54-year-old multigravida menopausal woman who previously underwent cesarean section to deliver her second child. She was referred to our medical center after a 7 cm right ovarian mass with malignant potential was discovered. A diagnostic laparotomy was performed then confirmed the presence of a 10 cm gossypiboma attached to a metallic ring. This case is an alarming example highlighting the importance of adequate intraoperative counting of gauze and radiologic evaluation of chronic pelvic pain.
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Affiliation(s)
- Jisong Min
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Saemi Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-ji Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yagnik VD, Garg P, Patel MI, Yagnik B, Oza R, Dawka S. Gossypiboma: a rare complication diagnosed on esophagogastroduodenoscopy. ANZ J Surg 2022; 92:3065-3066. [PMID: 35112778 DOI: 10.1111/ans.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, India
| | | | - Bhargav Yagnik
- Department of Pathology, Accurex Diagnostic Laboratory, Patan, India
| | - Rajesh Oza
- Department of Medicine, Sadbhav Hospital, Patan, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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Celik H, Akin IB, Altay C, Bisgin T, Obuz F. Giant gossypiboma presenting as a pelvic mass. Radiol Case Rep 2021; 16:3308-3310. [PMID: 34484537 PMCID: PMC8403700 DOI: 10.1016/j.radcr.2021.07.075] [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: 07/15/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 10/26/2022] Open
Abstract
Gossypiboma is a foreign object, such as a mass of cotton matrix or a sponge, that is left behind in a body cavity during surgery. It is uncommon, mostly asymptomatic, and hard to diagnose. It may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. It should be included in the differential diagnosis of soft-tissue masses detected in patients with a history of a prior operation. We present a case of 36-year-old female who referred to emergency room with severe abdominal pain and distension. Imaging revealed a giant intra-abdominal mass resembling a soft tissue tumor, but revealed to be a giant gossypiboma caused by a sponge that was forgotten during previous ectopic pregnancy surgery. This case differs from others with the absence of findings supporting gossypiboma such as calcification or trapped gas bubbles and emphasizes the importance of this potentially life-threatening complication of surgery.
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Affiliation(s)
- Hakki Celik
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Isil Basara Akin
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Tayfun Bisgin
- Department of General Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Funda Obuz
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Sharma A, Biswal D, Sharma S, Roy S. Gossypiboma: An uncommon but avoidable dreadful complication. Urologia 2021; 90:185-188. [PMID: 33845708 DOI: 10.1177/03915603211010636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gossypiboma or retained surgical sponge in abdominal cavity is an avoidable complication which has wide variety of clinical presentations and associated medico-legal issues as well. The incidence is under-reported. Pre-operative diagnosis is difficult and management is surgical. We present a case of gossypiboma in a male with multiple vesico-cutaneous and colo-vesical fistulae.
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Affiliation(s)
- Amit Sharma
- All India Institute of Medical Sciences - Raipur, Raipur, CT, India
| | - Deepak Biswal
- All India Institute of Medical Sciences - Raipur, Raipur, CT, India
| | - Satyadeo Sharma
- All India Institute of Medical Sciences - Raipur, Raipur, CT, India
| | - Siddhant Roy
- All India Institute of Medical Sciences - Raipur, Raipur, CT, India
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Yash W, Rajeev R, Manit G, Manish A. Gossypiboma: What Happens When a Mop is Left in a Thigh for ten Years. J Orthop Case Rep 2020; 10:12-15. [PMID: 33312970 PMCID: PMC7706432 DOI: 10.13107/jocr.2020.v10.i05.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Gossypiboma is an iatrogenic lesion, caused by a retained surgical sponge in the operating field. It is an extremely rare event following musculoskeletal procedures and has devastating medicolegal consequences. It is hardly ever reported, and hence, the incidence is difficult to determine. Case Report: We present a case report of a 70-year-old gentleman who presented with a painless swelling in the right thigh for 7 months. He had undergone open femoral nailing 10 years ago. Imaging studies suggested a soft-tissue sarcoma, but the biopsy was not conclusive. Intraoperatively, the mass was excised and found to have a thick fibrous wall with a gauze piece inside. Polarizing microscopy confirmed the diagnosis of gossypiboma. Conclusion: Gossypiboma is an infrequent but devastating consequence of a human error. It is often difficult to diagnose and is confused with a soft-tissue sarcoma. Prevention of such untoward incidents by strict adherence to protocols is far better than cure.
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Affiliation(s)
- Wagh Yash
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Reddy Rajeev
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Gundavda Manit
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Agarwal Manish
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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El Zemity H, Hakami N, Alfaki MAA, Khurizi M, Al-Zahrani A. Intra-Abdominal Gossypiboma: A Rare Cause of Palpable Abdominal Mass With a Review of Literature. Cureus 2020; 12:e10930. [PMID: 33194496 PMCID: PMC7660124 DOI: 10.7759/cureus.10930] [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] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Abstract
Gossypiboma is a term used to describe a pseudotumor caused by accidental retention of surgical swab or sponge in the body after surgery. The abdominal cavity is the most common site of retained surgical sponge. It is quite an infrequent surgical complication which is usually rarely reported because of the fear of medico-legal consequences. Here, we are reporting a case of a 26-years-old woman referred to our outpatient surgery clinic (OPD) from another hospital with complaint of intermittent abdominal pain, fever, and abdominal lump for 4 months following removal of IUD, which was attempted laparoscopically, and later converted to open laparotomy. She also had a history of cesarean section done one and half year ago in the same hospital. Clinical examination revealed a palpable abdominal mass in the para-umblical region. However, a computed tomography (CT) revealed a huge intra-abdominal mass. A diagnosis of intra-abdominal gossypiboma was suggested and the patient underwent exploratory laparotomy where the diagnosis was confirmed and the mass was excised.
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10
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Kori R, Bains L, Jain SK. Intravesical gossypiboma: our experience and the need for stringent checklist and training! BMJ Case Rep 2019; 12:12/2/e227278. [PMID: 30709885 PMCID: PMC6366893 DOI: 10.1136/bcr-2018-227278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present our experience of two cases: one of a 28-year-old male patient who presented with recurrent episodes of urinary tract infection (UTI) with passage of pus flakes in urine and a history of open cystolithotomy about 10 months ago. The second patient was a 26-year-old woman who underwent bladder exploration for a retained Double-J stent about 10 months ago and presented with recurrent UTI. The first case was treated with open surgery and in the second case, the gauze piece was retrieved endoscopically.
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Affiliation(s)
- Ronal Kori
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Lovenish Bains
- General Surgery, Maulana Azad Medical College, New Delhi, India
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Turgut M, Akhaddar A, Turgut AT. Retention of Nonabsorbable Hemostatic Materials (Retained Surgical Sponge, Gossypiboma, Textiloma, Gauzoma, Muslinoma) After Spinal Surgery: A Systematic Review of Cases Reported During the Last Half-Century. World Neurosurg 2018; 116:255-267. [PMID: 29807184 DOI: 10.1016/j.wneu.2018.05.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Retention of nonabsorbable hemostatic materials (RNHMs), that is, retained surgical sponge, gauzoma, gossypiboma, muslinoma, or textiloma, is a rarely seen surgical complication after spinal surgery that may remain asymptomatic for many years and may represent a diagnostic difficulty with associated medicolegal implications. METHODS We performed a systematic review of the English-language literature published between 1965 and 2017, accessed through 4 popular databases. We found a total of 37 articles (24 case reports; 7 image presentations; 5 clinical series, and 1 letter to editor) containing 58 cases of RNHMs located within the spinal canal or around the spinal column after surgery. RESULTS In this study, there were 29 female and 29 male patients from 13 countries, ages ranging from 17 years to 87 years, with initial diagnoses of lumbar or cervical disc herniation, spinal stenosis, or spondylolisthesis (n = 54), or spinal tumor (n = 4). The interval from the initial surgery to the presentation of RNHMs ranged from 13 days to 40 years, with a mean of 75.9 months. Various imaging techniques such as computed tomography and magnetic resonance imaging were used with histologic study, confirming the presence of RNHMs in the majority of patients with a complete recovery resulting in 93% of patients. CONCLUSIONS RNHMs is an overreported entity in underdeveloped or developing countries, including Turkey and Morocco, with progression occurring over years. RNHMs should be considered in the differential diagnosis of any patient who presents with back pain, spinal cord, or nerve roots symptomatology after spinal surgery.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey.
| | - Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V. University in Rabat, Rabat, Morocco
| | - Ahmet T Turgut
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Dalgic A, Kandogan T, Gonullu H, Erkan N. Retained Gauze Material in the Nasal Cavity after Functional Endoscopic Sinus Surgery for Ten Years: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of retained packing gauze material in the right nasal cavity for ten years. A 55-year-old woman presented to the emergency service with headache, nasal discharge, and epistaxis from the right nasal cavity. Her past surgical history included a functional endoscopic sinus surgery because of nasal polyposis 10 years ago. In the endoscopic nasal examination, foreign body similar to nasal packing material about 5 cm in length was detected in the right anterior ethmoid sinus. CT of the paranasal sinuses showed only loss of aeration in the right nasal cavity. The nasal packing material was removed under local anaesthesia on the same day. Foreign body left behind after operation is a serious medicolegal issue and is often under-reported.
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Affiliation(s)
- A Dalgic
- Izmir Bozyaka Teaching and Research Hospital, Department of Otolaryngology, Bozyaka Izmir, Turkey
| | - T Kandogan
- Izmir Bozyaka Teaching and Research Hospital, Department of Otolaryngology, Bozyaka Izmir, Turkey
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Sahoo RK, Tripathy P, Das PB, Mohapatra D. Gossypiboma complicated with paraspinal abscess and lumbar sinus: An uncommon complication of posterior lumbar spinal surgery. Asian J Neurosurg 2017; 12:211-213. [PMID: 28484533 PMCID: PMC5409369 DOI: 10.4103/1793-5482.148804] [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] [Indexed: 11/28/2022] Open
Abstract
A 42-year-old female presented with the complaint of purulent discharging sinus over posterior lumbar area following one month of lumbar spinal surgery for prolapsed intervertebral disc. Gossypiboma complicated with paraspinal abscess and sinus track formation over posterior lumbar area was diagnosed in magnetic resonance imaging which was confirmed in re- exploration of lumbar spinal operative site.
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Affiliation(s)
- Ranjan Kumar Sahoo
- Department of Radiology, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Pradipta Tripathy
- Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Pulin Bihari Das
- Department of Orthopedic, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Debahuti Mohapatra
- Department of Pathology, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
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Chopra S, Suri V, Sikka P, Aggarwal N. A Case Series on Gossypiboma - Varied Clinical Presentations and Their Management. J Clin Diagn Res 2016; 9:QR01-3. [PMID: 26816953 DOI: 10.7860/jcdr/2015/15927.6978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/02/2015] [Indexed: 11/24/2022]
Abstract
Retained surgical sponges in the peritoneal cavities are an infrequent operative/surgical complication and an error which is avoidable. The unfortunate situation of forgotten or missed foreign bodies after any surgical procedure may lead to medico legal problems. Though gossypiboma can be found at any operative site but intraperitoneal cavity is the most frequent site reported in literature. Over a period of three years, June 2009-2012, we conducted retrospective analysis of case summaries of eight patients who underwent re-laparotomy for retained surgical sponge at our institute. Pre operative diagnosis was made in 7out of 8 patients, 5 of whom underwent re-laparotomy and one had sponge removed through the caesarean incision, while in another it was removed per-vaginum through the open vault (post hysterectomy). In one patient, gossypiboma was an incidental finding on laparotomy done for adnexal mass. There was no mortality in any of the cases.
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Affiliation(s)
- Seema Chopra
- Assistant Professor, Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Vanita Suri
- Professor, Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Pooja Sikka
- Assistant Professor, Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Neelam Aggarwal
- Associate Professor, Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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Changes in computed tomography findings according to the chronicity of maxillary sinus gossypiboma. J Craniofac Surg 2015; 25:e330-3. [PMID: 24978684 DOI: 10.1097/scs.0000000000000594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present report describes a case of gossypiboma in the maxillary sinus after treatment for the fracture of the orbital floor with review of the literatures on this interesting disease entity. The suspicion of gossypiboma should be raised when a patient with a history of previous sinonasal surgery, especially Caldwell-Luc approach, presents with chronic recurrent or refractory sinusitis. Because of the rarity of reported cases, typical computed tomography findings of gossypiboma in the sinonasal area have not been established. In the present case, because the gauze was retained for 25 years in the maxillary sinus, computed tomography findings revealed nonspecific findings. Because a foreign body left behind after operation may lead to a serious medicolegal issue, it is worth reemphasizing that the best general approach to retained surgical foreign body is to prevent its occurrence.
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Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature. Case Rep Surg 2015; 2014:713428. [PMID: 25580346 PMCID: PMC4279710 DOI: 10.1155/2014/713428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 38-year-old lady who presented with vague pain and chronic lump in the right iliac fossa region. She had a history of cesarean section 4 years ago. Radiological investigations were inconclusive in detecting the retained sponge. A working diagnosis of mesenteric cyst was made and an exploratory laparotomy was done where she was found to have a large gossypiboma densely adhered to the small bowel and surrounding structures. Though rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain or chronic lump even years after the operation.
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Silva SME, Sousa JBD. [Gossypiboma after abdominal surgery is a challenging clinical problem and a serious medicolegal issue]. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:140-3. [PMID: 24000029 DOI: 10.1590/s0102-67202013000200015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 11/27/2012] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The term "gossypiboma" refers to a textile matrix surrounded by foreign body reaction. Gauze and surgical dressings are the most commonly retained materials after laparotomy. AIM To evaluate the incidence of abdominal gossypiboma, its causes and the preventive measures to reduce the frequence and morbimortality. METHOD Was conducted a literature review in Medline/Pubmed in english. The survey was about the last 10 years, selecting the headings: gossypiboma, textiloma, retained foreign body and abdominal surgery. Thirty articles were considered in this review. RESULTS The incidence of gossypiboma is underreported, mostly due to the legal implications of their detection but also because many patients remain asymptomatic. Occur in 1/1000 to 1/1500 of intra-abdominal operations. Clinical presentation is variable, and depends on the location of the foreign body and on the type of inflammatory reaction presented by the host. The recommended course of treatment is excision, which can be accomplished endoscopically, laparoscopically, or via the open route, and seeks to prevent the complications that lead to a high mortality rate. The most important approach is prevention. Preventive measures required include exploration of the abdominal cavity at the end of the procedure, use of textiles with radiopaque markers and a meticulous account of surgical materials. CONCLUSION Gossypiboma is a former medical-legal problem, whose incidence is apparently increasing. Therefore needs to be revised to take preventive measures in the operating room.
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Sahin S, Atabey C, Simşek M, Naderi S. Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour. Balkan Med J 2013; 30:422-8. [PMID: 25207152 DOI: 10.5152/balkanmedj.2013.8732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. AIMS The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. STUDY DESIGN Retrospective study. METHODS This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. RESULTS The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. CONCLUSION Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes.
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Affiliation(s)
- Soner Sahin
- Department of Neurosurgery, Kocaeli Derince Research and Teaching Hospital, Kocaeli, Turkey
| | - Cem Atabey
- Department of Neurosurgery, Gülhane Military Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Mehmet Simşek
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
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Lata I, Kapoor D, Sahu S. Gossypiboma, a rare cause of acute abdomen: A case report and review of literature. Int J Crit Illn Inj Sci 2012; 1:157-60. [PMID: 22229142 PMCID: PMC3249850 DOI: 10.4103/2229-5151.84805] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Indu Lata
- Departments of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
Retained foreign bodies can be a challenging diagnosis due to the wide array of presentations and greatly varied range of time to detection. Here we report a case of a retained surgical sponge detected 5 years postoperatively after an extensive workup for colon cancer. This case demonstrates the novel finding of a retained surgical sponge appearing as colon cancer and serves as a reminder that symptoms that cannot be explained by a standard workup, in any patient who has undergone previous surgery, must have retained surgical instruments as a differential diagnosis.
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Experimental study of artificially induced intramuscular gossypiboma in rabbits: correlation of sequential MRI findings with pathologic findings. AJR Am J Roentgenol 2012; 199:W114-22. [PMID: 22733919 DOI: 10.2214/ajr.11.7614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the sequential MRI findings of intramuscular gossypiboma and to correlate them with the pathologic findings in rabbits. MATERIALS AND METHODS Sterile gauze was packed in the hamstring muscles of 12 rabbits, and sequential MR images were obtained 1, 2, and 4 weeks and 2, 6, and 12 months after gauze insertion. Two rabbits were sacrificed at each time point. Their pathologic findings were compared with the MRI findings on each date. RESULTS At the acute stage, the gossypibomas appeared as areas of heterogeneous low signal intensity on T2-weighted MR images with inflammatory change around the gossypiboma. In the subacute stage, the gossypibomas appeared as areas of peripheral low and central high signal intensity with wavy stripes of low signal intensity on T2-weighted images. On contrast-enhanced fat-suppressed T1-weighted images, the peripheral enhancement of the masses advanced toward the center of the mass as the fibrocollagenization between the gauze bundles progressed centrally. In the chronic stage, on contrast-enhanced fat-suppressed T1-weighted images, central advancement of the peripheral enhancement occurred according to the maturation of the fibrocollagenization. Calcifications around individual gauze fibers were observed 6-12 months after gauze insertion. CONCLUSION On sequential contrast-enhanced fat-suppressed T1-weighted images of rabbits, intramuscular gossypiboma exhibited a chronologic centripetal enhancement pattern for 1 year mainly owing to concentric progression of fibrocollagenization between gauze bundles toward the center of the mass.
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Tan VES, Sethi DS. Gossypiboma: an unusual intracranial complication of endoscopic sinus surgery. Laryngoscope 2011; 121:879-81. [PMID: 21305547 DOI: 10.1002/lary.21257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 05/04/2010] [Indexed: 11/05/2022]
Abstract
We report a case of a 52-year-old man who presented with iatrogenic bilateral nasoethmoidal meningoencephaloceles following endoscopic nasal surgery performed in a neighboring country 8 years ago. Imaging studies, including computed tomography and magnetic resonance imaging of the paranasal sinuses and anterior skull base, demonstrated bilateral meningoencephaloceles and a suspicious intracranial lesion. In view of the intracranial lesion and size of the skull base defect, an external approach via a bicoronal flap was used for exploration and repair. Intraoperative findings revealed the suspicious intracranial lesion to be a retained piece of gauze. The patient underwent a successful removal of the foreign body and repair of the skull base defect. Postoperative recovery was uneventful. To our knowledge, an iatrogenic intracranial foreign body following an endonasal endoscopic procedure has never been reported before.
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F-18 FDG PET of foreign body granuloma: pathologic correlation with imaging features in 3 cases. Clin Nucl Med 2011; 35:853-7. [PMID: 20940541 DOI: 10.1097/rlu.0b013e3181f483da] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Retained textiles with foreign body granulomatous reaction can form mass-mimicking soft tissue tumors, which may cause diagnostic, clinical, and medicolegal problems. In this study, we present 3 cases of foreign body granuloma by retained textiles, and demonstrate FDG PET findings with detailed pathologic correlation. We also provide a review of previous literatures. MATERIALS AND METHODS Three patients (all females; age range, 48-61 years) with histopathologic diagnosis of mass-forming foreign body granuloma caused by retained textiles were retrospectively studied. They underwent an FDG PET scan in our institute. The mass was located in the abdominopelvic cavity in all cases. The time interval between the prior surgery and the PET acquisition was 11 months, 15 or 19 years, and 26 years, respectively. RESULTS Intense FDG uptake with a ring-shaped pattern was observed in 2 cases, while no uptake in 1 case. Microscopically, 2 with ring-shaped FDG uptake showed a cellular foreign body reaction peripherally, and artificial textile fibers and acellular eosinophilic amorphous materials in the central portion. In the one without FDG uptake, the mass was composed of mainly necrotic debris surrounding by a thick layer of well-formed collagen fibers. In previous case reports describing the accumulation of FDG in foreign body granulomas, 9 of 10 cases showed intense FDG uptake with a ring-shaped pattern. CONCLUSIONS The ring-shaped pattern of FDG uptake seems to well characterize pseudotumor with foreign body granulomas. However, the pattern of FDG accumulation in retained textile with foreign body granulomas may vary due to histologic features.
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Yeh CC, Kuo YL, Liu HS, Hsi SC, Kao CC, Chu TW. Gossypiboma mimicking an ovarian tumor in a young woman with a history of ovarian teratoma. Taiwan J Obstet Gynecol 2010; 49:225-7. [PMID: 20708537 DOI: 10.1016/s1028-4559(10)60050-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2009] [Indexed: 12/26/2022] Open
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Retained intraabdominal gossypiboma, five years after bilateral orchiopexy. Case Rep Med 2010; 2010:420357. [PMID: 20224652 PMCID: PMC2833312 DOI: 10.1155/2010/420357] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 01/26/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction. Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Intraabdominal surgical sponge is an uncommon surgical error. The incidence of gossypiboma has been reported as high as 1 in 1000 to 15,000 intraabdominal operations. Gossypiboma may cause serious morbidity and may lead to mortality. Case presentation. Herein, we report a 24 years-old man who was admitted due to the intraabdominal mass after evaluation of primary infertility. He had a surgical history of bilateral abdominal orchiopexy 5 years previously, performed at another hospital. Hydatid cyst was suspected by abdominal computed tomography. After laparotomy excision, the cyst wall opened incidentally, and draining of a large amount of thick pus with retained surgical gauze within the cyst was found, with final diagnosis of gossypiboma. Conclusion. The policy that prevention is far more important than cure is highly appreciated. Accurate sponge and instrument counts, along with radiologic evaluation when a discrepancy is found, can be helpful. Although human errors cannot be completely avoided, continuous medical training and strict adherence to rules of the operation room should reduce the incidence of gossypiboma to a minimum. Surgical sponges should be counted once at the start and twice at the end of all surgical operations.
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The importance of medico-legal evaluation in a case with intraabdominal gossypiboma. Forensic Sci Int 2010; 198:e15-8. [PMID: 20163926 DOI: 10.1016/j.forsciint.2010.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 12/11/2009] [Accepted: 01/23/2010] [Indexed: 12/25/2022]
Abstract
Data concerning the incidence of gossypiboma tend to fluctuate and is difficult to estimate because of a low reporting rate lest medico-legal implication. Gossypiboma is frequently located in the abdominal and pelvic cavities after gynecologic and upper abdominal surgical operations but can also follow thoracic, orthopedic, and urological and neurosurgical procedures. In medical literature, there are few articles about the medico-legal evaluation of gossypiboma although it is typically subjected to a medico-legal process. In this article, we reported a 22-year-old female case with intraabdominal gossypiboma following a cesarean procedure and discussed the importance of medico-legal evaluation of gossypiboma.
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Abstract
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.
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Martins MCB, Amaral RPG, Andrade CS, Lucato LT, Leite CDC. Características de imagem na ressonância magnética de gossipiboma intracraniano: relato de caso e revisão da literatura. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000600016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vários trabalhos têm descrito as características de gossipibomas por meio de radiografias convencionais e tomografia computadorizada, porém, seus achados na ressonância magnética são menos conhecidos. O objetivo deste estudo foi descrever as características de imagem de gossipibomas, ilustrando um caso de uma paciente com quadro clínico de febre e confusão mental com antecedente de cirurgia encefálica.
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Horvat JV, Machado RC, Vandesteen L, Moll RS, Oliveira GA. Intussusception following transmural migration and defecation of a surgical sponge. Clin Radiol 2009; 64:1231-4. [PMID: 19913134 DOI: 10.1016/j.crad.2009.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Affiliation(s)
- J V Horvat
- Federal University of Espirito Santo, Vitoria, Brazil.
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Textiloma: en el diagnóstico diferencial de masas abdominales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Wailly P, Desurmont T, Arnault V, Soro K, Huten N, Kraimps JL. [Postoperative textiloma and cancer]. JOURNAL DE CHIRURGIE 2009; 146:327-328. [PMID: 19640532 DOI: 10.1016/j.jchir.2009.06.007] [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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Deschamps JY, Roux FA. Extravesical Textiloma (Gossypiboma) Mimicking a Bladder Tumor in a Dog. J Am Anim Hosp Assoc 2009; 45:89-92. [DOI: 10.5326/0450089] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sponges can be inadvertently left behind during surgery. A retained surgical sponge is called a textiloma, gossypiboma, or gauzoma. This complication is rare and rarely reported. These foreign bodies can lead to postoperative infection or abscess formation, while others remain asymptomatic for many years before leading to a granuloma with adhesions. This paper reports a case of extravesical textiloma in a spayed female dog with severe hematuria and a thickened bladder wall, mimicking a tumor on ultrasound. Clinical signs occurred >8 years after sterilization.
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Affiliation(s)
- Jack-Yves Deschamps
- Department of Clinical Sciences, Emergency and Critical Care Unit, Nantes School of Veterinary Medicine, Atlanpole, La Chantrerie, BP 40 706, 44 307 Nantes cedex 03, France
- From the
| | - Françoise A. Roux
- Department of Clinical Sciences, Emergency and Critical Care Unit, Nantes School of Veterinary Medicine, Atlanpole, La Chantrerie, BP 40 706, 44 307 Nantes cedex 03, France
- From the
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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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Abstract
Gossypiboma is composed of non-absorbable surgical material with a cotton matrix. Gossypiboma is usually under-reported and is a severe medicolegal issue. Thus, we describe the computed tomography (CT) findings of gossypiboma in our institution. From January 2003 to June 2006, gossypibomas diagnosed in our institution and their data regarding sex, age, previous operation, location, the interval between the operation and the diagnosis of gossypiboma, clinical presentation, indication of CT, CT findings and further management were collected. There were 6 cases of gossypiboma, 4 men and 2 women. Three of our cases had previous chest surgery and the other 3 cases had previous abdominal surgery. The locations of 3 (50%) cases were in the left anterior subphrenic space. The mean interval between original operation and diagnosis was 24.6 +/- 33.4 months (range, 17 days to 8 years). With regard to CT findings, 3 (50%) cases had an isodense mass and 3 (50%) had a typical mass containing curvilinear opaque structures. The mean size of the gossypibomas was 62 x 62 x 67 mm. Because gossypiboma is due solely to human factors and is a severe medicolegal issue, continuous education should be considered.
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Affiliation(s)
- Tzu-Chieh Cheng
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan, R O C
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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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Affiliation(s)
- Hung-Shun Sun
- Division of Urology, Chung-Shan Medical University Hospital, Taichung, Taiwan, ROC
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Yoo E, Kim JH, Kim MJ, Yu JS, Chung JJ, Yoo HS, Kim KW. Greater and lesser omenta: normal anatomy and pathologic processes. Radiographics 2007; 27:707-20. [PMID: 17495288 DOI: 10.1148/rg.273065085] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The peritoneum is the largest serous membrane in the body and the one with the most complex structure. The omentum is a double-layered extension of the peritoneum that connects the stomach to adjacent organs. The peritoneal reflections form the greater and lesser omenta, and the natural flow of peritoneal fluid determines the route of spread of intraperitoneal fluid and consequently of disease processes within the abdominal cavity. The omenta serve both as boundaries for disease processes and as conduits for disease spread. The omenta are frequently involved by infectious, inflammatory, neoplastic, vascular, and traumatic processes. Computed tomography (CT) is a primary diagnostic method for evaluation of omental diseases, most of which may manifest with nonspecific clinical features. Multidetector CT with multiplanar reformation allows accurate examination of the complex anatomy of the peritoneal cavity, knowledge of which is the key to understanding the pathologic processes affecting the greater and lesser omenta.
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Affiliation(s)
- Eunhye Yoo
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea
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Puri A, Anchan C, Jambhekar NA, Agarwal MG, Badwe RA. Recurrent gossypiboma in the thigh. Skeletal Radiol 2007; 36 Suppl 1:S95-100. [PMID: 17091309 DOI: 10.1007/s00256-006-0200-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 07/03/2006] [Accepted: 08/02/2006] [Indexed: 02/02/2023]
Abstract
Gossypiboma, an iatrogenic mass lesion caused by a retained surgical sponge is an extremely rare event following musculoskeletal procedures. This entity is therefore a very unusual experience and can create considerable confusion. Unsuspecting surgeons may thus be caught out by this unlikely presentation. We present our experience with a recurrent gossypiboma in the thigh occurring several years after surgical evacuation of a similar gossypiboma from the same anatomic location with interval resolution of symptoms. The purpose of this case report is to highlight the possibility of a "recurrent" soft tissue mass occurring for reasons other than a neoplasm. In the absence of a definitive biopsy diagnosis of tumor in patients who have undergone prior surgical procedures in that area, it may be more prudent to adopt a conservative surgical resection rather than a conventional radical resection as warranted by the dramatic clinical presentation mimicking a soft tissue sarcoma.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai 400 012, India.
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Wieder HA, Feussner H, Rummeny EJ, Gaa J. [Radiological diagnostics for iatrogenic retained foreign bodies after surgery]. Chirurg 2007; 78:22-7. [PMID: 17151841 DOI: 10.1007/s00104-006-1279-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- H A Wieder
- Institut für Röntgendiagnostik, Klinikum Rechts der Isar, Technische Universität, Ismaningerstrasse 22, 81675 Munich, Germany.
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Affiliation(s)
- Prachi P Agarwal
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Affiliation(s)
- John A Vento
- University of Connecticut Health Center, Department of Diagnostic Imaging & Therapeutics, Division of Nuclear Medicine, Farmington, CT 06030-2804, USA.
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Ribalta T, McCutcheon IE, Neto AG, Gupta D, Kumar AJ, Biddle DA, Langford LA, Bruner JM, Leeds NE, Fuller GN. Textiloma (Gossypiboma) Mimicking Recurrent Intracranial Tumor. Arch Pathol Lab Med 2004; 128:749-58. [PMID: 15214828 DOI: 10.5858/2004-128-749-tgmrit] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Resorbable substances used to achieve hemostasis during neurosurgical procedures comprise 3 principal classes based on chemical composition: (1) gelatin sponge, (2) oxidized cellulose, and (3) microfibrillar collagen. Nonresorbable hemostatic aides include various forms of cotton and rayon-based hemostats (cottonoids and kites). Resorbable and nonresorbable hemostatic agents have been reported to cause symptomatic mass lesions, most commonly following intra-abdominal surgery. Histologic examination typically shows a core of degenerating hemostatic agent surrounded by an inflammatory reaction. Each agent exhibits distinctive morphologic features that often permit specific identification. Hemostat-associated mass lesions have been variously referred to as textilomas, gossypibomas, gauzomas, or muslinomas.
Objectives.—The aims of this study were to (1) identify cases of histologically proven cases of textiloma in neurosurgical operations, (2) characterize the specific hemostatic agent associated with textiloma formation, and (3) characterize the preoperative magnetic resonance imaging appearance of textiloma.
Design.—Cases in which a textiloma constituted the sole finding on repeat surgery for recurrent brain tumor, or was a clinically significant component of a radiologically identified mass lesion together with residual tumor, constituted the study set.
Results.—Five textilomas were identified and evaluated. The primary neoplasm was different in each case and included pituitary adenoma, tanycytic ependymoma, anaplastic astrocytoma, gliosarcoma, and oligodendroglioma. In all cases, preoperative magnetic resonance imaging suggested recurrent tumor. Textilomas included all categories of resorbable hemostatic agent. Other foreign bodies were present in some cases; the origin of these foreign bodies was traced to fibers shed from nonresorbable hemostatic material placed temporarily during surgery and removed before closure (cottonoids and kites). Inflammatory reactions included giant cells, granulomas, and fibroblastic proliferation. Microfibrillar collagen (Avitene) textilomas were associated with a striking eosinophil infiltration that was not seen with any other hemostatic agent.
Conclusions.—Hemostatic agents may produce clinically symptomatic, radiologically apparent mass lesions. When considering a mass lesion arising after intracranial surgery, the differential diagnosis should include textiloma along with recurrent tumor and radiation necrosis.
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Affiliation(s)
- Teresa Ribalta
- Department of Pathology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Suñer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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