Foreign body reaction to a retained surgical sponge (gossypiboma) mimicking an implant associated sarcoma in a dog after a tibial plateau levelling osteotomy

Intra-thoracic gossypiboma (textiloma) in a 6-year-old cocker spaniel

This report documents the first case of gossypiboma (textiloma) identified within the thorax of a dog. CT findings, surgical removal and histopathology are described. Intra-thoracic gossypiboma has not previously been reported in dogs and is rarely reported in the human medical literature, where it is most commonly associated with previous cardiac or pulmonary surgery. This dog had previously had a thoracotomy for attempted surgical correction of a persistent right aortic arch and left ligamentum arteriosum 6 years prior to presentation. A brief review of the previous literature and recommendations for prevention of this condition are provided.

Novel CT Features of an Abdominal Gossypiboma in a Female Dog

Case Description

An eight-year-old Golden Retriever was presented with hypercalcemia and a complex abdominal mass.

Clinical Findings

A well-defined, heterogeneously contrast-enhancing, cavitary, soft tissue attenuating, non-organ associated abdominal mass was identified caudal to the right kidney. This mass was confluent with the distal tip of the right limb of the pancreas. A connected large, rim enhancing, cystic subcutaneous mass was also present in the right lumbar subcutaneous tissues, and there were multiple fistulous tracts through the hypaxial musculature.

Treatment and Outcome

The dog underwent a surgical exploratory laparotomy and a gossypiboma was removed from the intra-abdominal mass; the cystic extra-abdominal mass was drained percutaneously. Surgical recovery was uneventful and a follow-up CT after 3 months was consistent with resolving granulomatous inflammation and fibrosis.

Clinical Relevance

The presence of multiple peripherally enhancing tracts extending from the abdominal mass through the hypaxial musculature is a CT feature which has not yet been described in the veterinary literature. Additionally, incorporation of the pancreas into the abdominal mass has also not yet been described in the veterinary literature.

Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review

Although the incidence of retained surgical items (RSIs) is low, it is nevertheless an important preventable cause of patient injury that can ultimately lead to the patient's death and to subsequent high medical and legal costs. Unintentional RSI is the cause of 70% of re-interventions, with a morbidity of 80% and mortality of 35%. The most common RSIs are sponges or gauze (gossypiboma or textiloma), while retained surgical instruments and needles are rare. Perioperative counting of equipment and materials is the most common method of screening for RSIs, while a diagnosis can later be confirmed by the clinical appearance and by imaging studies. We present a rare case of a 43-year-old patient who was admitted to our hospital because of two retained needles following a cesarean section, despite several subsequent laparotomies. One needle had been removed previously, but in addition to the remaining needle, we also removed a retained gauze. The diagnosis of RSIs is extremely important, and safe surgical practices including the addition of new imaging technologies should be encouraged to detect RSIs.

Handling of the tibial muscle envelope in tibial plateau levelling osteotomy - to elevate or not?

Objective: To compare the outcome of the tibial plateau levelling osteotomy (TPLO) procedure, using a 6-hole 3.5 mm locking TPLO plate and performed with the muscle elevation technique (ET) and placement of sponges, to the TPLO without performing these steps (non-elevation-technique [NET]).

Material and methods: Medical records and radiographs of dogs with ET (n = 21) or NET (n = 19) were retrospectively reviewed. Signalment, TPLO procedure side, meniscal treatment, surgery time, haemorrhage, preand postoperative tibial plateau angle, assistant, amount of rehabilitation, bone healing (cortical, osteotomy, combined healing scores), complications, limb function, recovery time and follow-up were recorded and analysed using multivariate analysis. A value of p <0.05 was considered significant.

Results: Surgery time was significantly shorter with the NET (68.5 min ± 3.4) than with the ET (87.8 min ± 3.4) (p <0.01). No significant differences were detected for all other evaluated factors. Soft tissue trauma was minimal and none of the dogs suffered severe haemorrhage. The bone healing scores with the NET and the ET were not significantly different (p = 0.1, p = 0.2, p = 0.1). Complications were rare, minor and not significantly different between groups (p = 0.73).

Clinical relevance: The results of this in vivo study indicate that NET is a feasible technique that can be considered for the clinical setting.

Three years evaluation of retained foreign bodies after surgery in Iran

BACKGROUND

Medical errors such as retained foreign bodies (RFB) during surgery are not well studied. To define risk factors associated with this type of error, we performed retrospective study.

METHODS

We reviewed medical records for unintentional foreign object remaining in the body during surgery such as gender, age, surgery ward, and incident reports referred to several forensic medicine administrations as well as adverse effects of retained foreign bodies and methods for detection of them over a 3-years period from January 2008 through May 2011.

RESULTS

Thirty eight patients were involved in the study to have retained foreign bodies (73% sponges and 27% other instruments including 7 (18.42%) cases of other bandages, 2 cases (5.26%) of scissor and 1 case (2.63%) of forceps). The general surgery ward was most commonly involved (47%) followed by the gynecology surgery ward (34%). Men (58%) were more involved with RFB than women (42%).

CONCLUSION

Considering the most frequent type of retained foreign bodies and also more frequent involved surgery wards besides detection methods for RFB, a mixed of preventing protocols such as regular counting of devices, post-operative X-ray with radiopaque markers and exact evaluation of surgery site should be employed to reduce the occurrence of retained foreign bodies and its complications.