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Jidal M, Horache K, Achemlal A, Saouab R, El Fenni J. Transgastric migration of retained intraabdominal surgical sponge: Gossypiboma in the fundus. Radiol Case Rep 2024; 19:2452-2456. [PMID: 38585404 PMCID: PMC10997863 DOI: 10.1016/j.radcr.2024.02.104] [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: 02/11/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
The retention of a surgical sponge is a rare complication that presents diagnostic challenges and carries the risk of potential complications. Two distinct foreign body reactions, fibrinous, and exudative, can result in the formation of a granuloma (known as gossypiboma) or lead to complications such as abscess formation and migration into the gastrointestinal tract. In this report, we present the case of a 33-year-old woman with a history of splenectomy who presented with symptoms including epigastric pain, vomiting, and episodes of hematemesis. Imaging studies, including computed tomography and magnetic resonance imaging, revealed a mass consistent with a gossypiboma that had migrated transmurally into the stomach. The diagnosis was subsequently confirmed through gastroscopy, and successful endoscopic removal of the retained surgical sponge was performed.
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Affiliation(s)
- Manal Jidal
- Radiology department, Mohammed V military hospital of Rabat, Rabat, Morocco
| | - Kenza Horache
- Radiology department, Mohammed V military hospital of Rabat, Rabat, Morocco
| | - Amine Achemlal
- Gastroenterology department, Mohammed V military hospital of Rabat, Rabat, Morocco
| | - Rachida Saouab
- Radiology department, Mohammed V military hospital of Rabat, Rabat, Morocco
| | - Jamal El Fenni
- Radiology department, Mohammed V military hospital of Rabat, Rabat, Morocco
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Chandrasinghe P, De Silva A, Welivita A, Deen K. Complete migration of a composite mesh into small bowel incidentally found during laparotomy for colectomy in an asymptomatic patient: a case report. J Med Case Rep 2020; 14:207. [PMID: 33126917 PMCID: PMC7602325 DOI: 10.1186/s13256-020-02540-4] [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: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Composite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient. Case presentation Our patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation. Conclusion To our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient.
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Affiliation(s)
- Pramodh Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Asantha De Silva
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Obeidat KA, Aleshawi AJ, Alebbini MM, Bani Yasin SN. Abdominal Intraluminal Gossypiboma: Demographics, Predictors of Intraluminal Site, Diagnostic and Treatment Measures. Clin Exp Gastroenterol 2020; 13:65-72. [PMID: 32161486 PMCID: PMC7051864 DOI: 10.2147/ceg.s236179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Intra-abdominal gossypiboma may present with variable clinical presentations. The clinical picture that the patient presents with depends on the site of the retained gauze in the abdomen, with transmural migration leading to intraabdominal gauze being a rare occurrence. We systemically analyze articles and reports related to the transmural migration of gossypiboma. In addition, we report a case of ileal transmigration of gossypiboma in a 53-year-old female. Methods A systematic literature review was conducted using Embase and Medline for articles pertaining to transmural migration of gossypiboma. Three of the authors extracted the data from the selected studies that relate to the topic. All articles included were in English language and published in peer-reviewed journals. This study was conducted according to the guidelines set out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 93 cases of intraluminal gossypiboma were found in the literature. The mean age of the patients was 40.4 years and females (77.7%) were affected more than males. The obstetric and gynecologic surgeries were the leading causative operation (41.5%). However, cholecystectomy is the most common single surgery associated with intraluminal gossypiboma. The mean time from the causative operation was 35.16 months. Most patients presented as intestinal obstruction. CT scan was the most sensitive tool to detect any non-specific finding while the endoscopic interventions were the most specific. Ileum is the most common site for intraluminal for migration. Intra-gastric location is related mostly to the hepato-biliary operations. Laparotomy with segmental resection provides a primary treatment and cure. Conclusion Clinicians should keep the possibility of gossypiboma, including intraluminal, in their mind when a patient presents with abdominal pain, signs of infection, intestinal obstruction, or a palpable mass any time after abdominal surgery. Measures for prevention and education are the most useful tool to avoid such complications.
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Affiliation(s)
- Khaled A Obeidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | | | - Mohanad M Alebbini
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Saja N Bani Yasin
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
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Singhal PM, Vats M, Neogi S, Agarwal M. Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula. BMJ Case Rep 2019; 12:12/6/e228587. [PMID: 31248892 DOI: 10.1136/bcr-2018-228587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.
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Affiliation(s)
| | - Manu Vats
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Sushanto Neogi
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Mehul Agarwal
- General Surgery, Maulana Azad Medical College, New Delhi, India
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de Gea Rico A, Krishna P, Devlin HL, Rohatgi A. Gossypiboma: a ghastly find. BMJ Case Rep 2018; 2018:bcr-2017-221537. [PMID: 30257871 PMCID: PMC6169625 DOI: 10.1136/bcr-2017-221537] [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] [Accepted: 08/10/2018] [Indexed: 11/03/2022] Open
Abstract
A gossypiboma is a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma presenting in a 32-year-old man with acute epigastric pain and haematemesis. His surgical history revealed an emergency laparotomy following a road traffic accident 16 years ago. Initial gastroscopy showed extrinsic stomach compression. An abdominal ultrasound scan followed by a CT scan evidenced a large, well-defined, predominantly cystic mass with some solid areas occupying the left hypochondrium. Conservative management with insertion of a percutaneous drain proved to be inefficient. A laparotomy was performed; intraoperatively, the cyst was found to be ruptured and within it, a large surgical gauze was found. This was removed but required a distal pancreatectomy and gastrectomy for complete excision. He was discharged on day 74 of admission with outpatient follow-up.
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Affiliation(s)
- Aitor de Gea Rico
- General Surgery Department, Whipps Cross University Hospital, London, UK
| | - Priya Krishna
- General Surgery Department, Whipps Cross University Hospital, London, UK
| | | | - Ashish Rohatgi
- General Surgery Department, Whipps Cross University Hospital, London, UK
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Gossypiboma with bleeding from fistula to the colon observed by colonoscopy. Clin J Gastroenterol 2016; 10:37-40. [PMID: 27815815 DOI: 10.1007/s12328-016-0699-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/22/2016] [Indexed: 12/22/2022]
Abstract
A gossypiboma is a mass of cotton sponge left in the body postoperatively. Here, we report a case of gossypiboma with bleeding through a fistula to the colon, which became clinically evident 24 years after gynecological surgery, and resembled a bleeding diverticulum at colonoscopy. A 67-year-old woman presented with anemia and hematochezia. She had undergone a hysterectomy for myoma uteri 24 years earlier. Colonoscopy showed a deep depressed lesion mimicking a diverticulum with bleeding in the transverse colon. A contrast-enhanced computed tomography was interpreted as revealing a 6-cm thick-walled tumor, containing an air bubble, and a fistula between the mass and the transverse colon. The patient underwent laparotomy, with the preoperative expectation that the mass was a penetrating submucosal tumor. Pathological findings revealed denatured cotton tissues surrounded by reactive tissues to the foreign body. Despite its rarity, gossypiboma should be considered in patients with an intra-abdominal mass who have a history of laparotomy. Gossypiboma can cause fistula to the colon and bleeding. Imaging studies and the clinical course may mimic a malignant tumor.
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[Intestinal occlusion secondary to a retained surgical item]. CIR CIR 2015; 84:503-508. [PMID: 26738642 DOI: 10.1016/j.circir.2015.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
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.
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Small Bowel Obstruction and Enterocolic Fistula from a Gossypiboma after Caesarean Section. W INDIAN MED J 2015; 63:539-40. [PMID: 25781298 DOI: 10.7727/wimj.2013.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/20/2013] [Indexed: 11/18/2022]
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Ojha S, Gall T, Sodergren MH, Jiao LR. A case of gossypiboma mimicking intrahepatic cholangiocarcinoma. Ann R Coll Surg Engl 2014; 96:e14-6. [PMID: 25245716 PMCID: PMC4473471 DOI: 10.1308/003588414x13946184901489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A gossypiboma refers to a cotton-based foreign body left inadvertently in the human body following a surgical procedure. Although a rare event, they tend to be found in the abdomen but few are known to be intrahepatic. CASE HISTORY We report the case of a 44 year-old man who presented with recurrent episodes of jaundice and cholangitis, on a background of a right hepatectomy for hydatid cyst excision 20 years previously. This case was discussed at our hepatobiliary multidisciplinary team meetings on several occasions and a presumed diagnosis of intrahepatic cholangiocarcinoma was made. Biopsies of the mass had purely shown inflammation and remained inconclusive. It was decided that the patient should undergo a complete extended right hepatectomy with resection and reconstruction of the left branch of the portal vein. On attempting to obtain intraoperative frozen section specimens prior to resection, open excision revealed two large swabs encased in a calcified cavity. Removal of the swabs resulted in resolution of the mass and obstructive symptoms. CONCLUSIONS Gossypiboma should be a rare differential diagnosis in all patients following a laparotomy presenting with obstructive symptoms, particularly in countries where strict surgical protocols may not be in place. This case also highlights the need to perform an intraoperative biopsy in any uncertain case of a liver lesion as we have shown that an extensive operation with its increased morbidity can occasionally be avoided.
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Affiliation(s)
- S Ojha
- Imperial College Healthcare NHS Trust, UK
| | - T Gall
- Imperial College Healthcare NHS Trust, UK
| | | | - LR Jiao
- Imperial College Healthcare NHS Trust, UK
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Lv YX, Yu CC, Tung CF, Wu CC. Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum--a case report and literature review. BMC Surg 2014; 14:36. [PMID: 24917191 PMCID: PMC4061322 DOI: 10.1186/1471-2482-14-36] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/05/2014] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Cheng-Chan Yu
- Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect, 4, Taichung, Taiwan.
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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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Rehman A, Baloch NUA, Awais M. Gossypiboma diagnosed fifteen years after a cesarean section: A case report. Qatar Med J 2014; 2014:65-9. [PMID: 25745595 PMCID: PMC4344979 DOI: 10.5339/qmj.2014.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/19/2014] [Indexed: 11/03/2022] Open
Abstract
Gossypiboma, a retained surgical sponge, is a rare complication following any surgical procedure and is primarily a result of human error. Such patients often have vague clinical presentations and the diagnosis often comes as a surprise. We present the case of a 40-year-old woman who had a long-standing history of lower abdominal discomfort. She was diagnosed with a gossypiboma fifteen years after a cesarean section. All general physicians, surgeons and radiologists must be aware of this rare but clinically significant entity.
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Affiliation(s)
- Abdul Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Noor Ul-Ain Baloch
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Gossypiboma causing mechanical intestinal obstruction: a case report. Case Rep Surg 2012; 2012:543203. [PMID: 23133784 PMCID: PMC3485905 DOI: 10.1155/2012/543203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/08/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.
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Day JL, Pechman RD, Bahr RJ. Migration of a retained surgical swab into the jejunum in a dog. J Small Anim Pract 2012; 53:705-8. [DOI: 10.1111/j.1748-5827.2012.01286.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J. L. Day
- Department of Radiology; University of Melbourne Veterinary Hospital; 250 Princes Highway; Werribee; 3030; Australia
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Umunna J. Gossypiboma and its implications. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2012; 2:95-105. [PMID: 25453006 PMCID: PMC4220479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Surgical materials are sometimes inadvertently left in the body after surgical operations. Cotton materials are the commonest objects forgotten. The implications for the patient and the surgeon are grave. The purpose of this presentation is to rekindle awareness of the phenomenon of gossypiboma, highlight the implications and stress prevention. Data were collected from hospital records which included their demographics, clinical features, management outcome and follow-up. Four cases of gossypiboma were found. Two had undergone caesarian section, one underwent pelvic floor repair for utero-vaginal prolapsed, and the fourth underwent transvesical prostatectomy. Their age, sex, causative operation and onset of symptoms, and salvage procedures were noted. Out of the 12304 surgical cases managed in our facility between November 1997 and December 2012, 4 (0.03%) cases of gossypiboma were recorded. Gauze extruded spontaneously from the abdominal scar in one patient who had undergone caesarian section. Intestinal obstruction occurred in another case of caesarian section and was relieved by intestinal resection and anastomosis. Also gauze extruded and was extracted from the urethra in the patient who underwent transvesical prostatectomy. Three (75%) patients survived while one (25%) died. We conclude that gossypiboma occurs most commonly after intra-abdominal operations. Women are at increased risk during obstetric and gynaecological operations, though both sexes are affected. The condition carries potentials for harm to the patient and medico-legal litigations.
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Akbulut S, Arikanoglu Z, Yagmur Y, Basbug M. Gossypibomas mimicking a splenic hydatid cyst and ileal tumor : a case report and literature review. J Gastrointest Surg 2011; 15:2101-7. [PMID: 21755387 DOI: 10.1007/s11605-011-1592-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/10/2011] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Kayapinar, Diyarbakir, Turkey.
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Ozyer U, Boyvat F. Imaging of a retained laparotomy towel that migrated into the colon lumen. Indian J Radiol Imaging 2011; 19:219-21. [PMID: 19881091 PMCID: PMC2766885 DOI: 10.4103/0971-3026.54889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Retention of surgical instruments, most commonly small laparotomy sponges, is a known complication of surgery. Such retained instruments may remain silent or may cause a variety of complications. We report a case in which a retained laparotomy towel migrated into the colon. This is an infrequently reported complication. We were able to document the passage of the towel through the colon on plain radiographs. The USG and MRI findings are also described.
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Affiliation(s)
- Umut Ozyer
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Modrzejewski A, Kiciak A, Sledż M, Sygit K, Borycka-Kiciak K, Grzesiak W, Tarnowski W. Migration of a foreign body into the colon and its autonomous excretion. Med Sci Monit 2011; 17:CS34-8. [PMID: 21358609 PMCID: PMC3524727 DOI: 10.12659/msm.881438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The frequency of foreign body retention in the abdominal cavity ranges from 1 in 100 to 1 in 3000 surgeries performed. Worldwide literature describes only a few cases of the migration of misplaced surgical gauze into the colon. CASE REPORTS The first case is a 60-year-old patient following laparoscopic cholecystectomy, who excreted (on his own) a cotton sheet 30 × 65 cm after 26 weeks, which did not possess a radiological locator. The latter fact caused diagnostic difficulties in interpreting ultrasonography, CT-scans and abdominal X-rays. Colonoscopy after 4 months following the excretion of the sheet showed flat, stretched ulceration of the colonic wall near the hepatic turn. The second case is a 76-year-old who had undergone several abdominal surgeries, including a classical cholecystectomy and extirpation of the uterus along with related tissues, as a result of cancer and with subsequent radiotherapy. The reason for the last intervention was an occlusion, which required a resection due to abscesses inside the peritoneal cavity. Abdominal pain continued after the surgery. Uroscopy and abdominal X-rays were performed 3 months later, which confirmed the presence of foreign matter in the abdominal cavity. CONCLUSIONS Most foreign objects that have migrated into the colon will be excreted autonomously, which warrants a conservative assessment. Radiologically-tagged materials should be used, which will greatly ease identification in cases of suspected retention of surgical materials in the abdominal cavity.
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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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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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Dakubo J, Clegg-Lamptey J, Hodasi W, Obaka H, Toboh H, Asempa W. An intra-abdominal gossypiboma. Ghana Med J 2009; 43:43-45. [PMID: 19652755 PMCID: PMC2709164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Inadvertent retention of a foreign body in the abdomen often require another surgery to recover the material. This increases morbidity and mortality. Risk factor that could predispose to a gossypiboma occurring have been reported. A 44-year old female in whom an abdominal sponge was left in the pelvis after a total abdominal hysterectomy is reported. Surgeons must be aware of the risk factors that lead to a gossypiboma and take measures to prevent it.
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Affiliation(s)
- J Dakubo
- Department of Surgery, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
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Alis H, Soylu A, Dolay K, Kalayci M, Ciltas A. Surgical intervention may not always be required in gossypiboma with intraluminal migration. World J Gastroenterol 2008. [PMID: 18161936 DOI: 10.3748/wjg.13.6605] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.
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Affiliation(s)
- H Alis
- General Surgery Department, Endoscopy Unit, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Alis H, Soylu A, Dolay K, Kalaycı M, Ciltas A. Surgical intervention may not always be required in gossypiboma with intraluminal migration. World J Gastroenterol 2007; 13:6605-7. [PMID: 18161936 PMCID: PMC4611305 DOI: 10.3748/wjg.v13.i48.6605] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.
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