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Bourabaa S, El Hamdani H, Hamid M, Zhim M, Settaf A. Gossypiboma mimicking a hydatid cyst: A case report. Int J Surg Case Rep 2023; 113:109034. [PMID: 37980773 PMCID: PMC10694283 DOI: 10.1016/j.ijscr.2023.109034] [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: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Retained foreign bodies have become very rare in countries where the safety rules in the operating theater are very rigorous and follow precise guidelines. Maintaining awareness of this issue among surgeons and radiologists is of paramount importance to minimize avoidable morbidity and facilitate the selection of the most suitable therapeutic strategy. This consideration is particularly relevant in the differential diagnosis of hydatid cysts. This study describes a case of intra-abdominal gossypiboma, which mimicked hydatid cyst on preoperative assessment. CASE PRESENTATION We report the case of a 63-year-old female who was referred to our department for the management of a hepatic hydatid cyst. She has history of open cholecystectomy and oophorocystectomy. During the intervention, we discovered a 10 cm mass located in the interhepatogastric region. Complete resection of the mass was performed, and pathology results were compatible with a piece of gauze surrounded by reactive changes (gossypiboma). DISCUSSION Gossypiboma is undeniably a source of concern for surgeons. It's a genuine and serious surgical complication which can potentially arise from any type of surgery and may manifest with diverse complaints. However, it is crucial to emphasize that this complication is preventable with the primary preventive measure being meticulous counting of surgical materials during the procedure. CONCLUSION The potential embarrassment experienced by the surgeon and the significant legal consequences associated with this iatrogenic complication are substantial. Hence, it becomes imperative to adopt all requisite preventive measures to avert such incidents, as there is no excuse that can justify their occurrence.
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Affiliation(s)
- S Bourabaa
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco.
| | - H El Hamdani
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - M Hamid
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - M Zhim
- Radiology Department, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - A Settaf
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
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Bai YF, Niu JQ, Zhang C, Wang W, Liu JZ. Computed Tomography and Magnetic Resonance Imaging Appearances of Abdomen and Pelvis Gossypibomas at the Varied Durations After Cesarean Section. Cureus 2021; 13:e18588. [PMID: 34765355 PMCID: PMC8575338 DOI: 10.7759/cureus.18588] [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: 10/06/2021] [Indexed: 11/15/2022] Open
Abstract
The incidence of gossypiboma is considerably higher in open cavity surgeries, among which cesarean section ranks number one. However, it is difficult to diagnose abdomen or pelvic gossypibomas after cesarean section. We retrospectively analyzed the clinical and imaging data of three pathologically confirmed gossypiboma patients at varied durations after cesarean section. In case one, at four months after cesarean section, a gossypiboma near the small intestine caused fistula and intestinal obstruction. Soft tissue density lesion along the intestinal canal made the “segmental honeycomb sign" and "truncation" with metal markings on the edge on computed tomography (CT). Magnetic sensitivity artifacts were demonstrated as hypointensity on T1 weighted image (T1WI) and T2 weighted image (T2WI), while hyperintensity was seen on the diffusion weighted image (DWI). In case two, a gossypiboma in the peritoneal and intestinal space was revealed with MRI at 18 months after cesarean section. It was featured as a cystic and solid lesion, with "vortex like sign" and obvious ring enhancement on contrast-enhanced MRI scan. In case three, five years after cesarean section, a mass was palpated in the right middle and lower abdomen. MRI revealed a round mass of T1 hypointensity with mixed T2 signal, as well as swirling hypointensity in T2WI, T2WI-fat suppression (FS), and DWI. In CT and MRI examinations for suspected gossypiboma after cesarean section, "honeycomb sign" and "vortex like sign" are the characteristic appearances; gauze translocated into the intestine may show the "truncation sign". Accurate diagnosis is based on the surgery history, symptoms, and imaging features.
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Affiliation(s)
- Yu-Feng Bai
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Juan-Qin Niu
- Department of Radiology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, CHN
| | - Chao Zhang
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Wen Wang
- Department of Radiology, Fourth Military Medical University, Shaanxi, CHN
| | - Jing-Zhong Liu
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
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Bozkırlı BO, Gündoğdu RH, Ersoy PE, Akbaba S, Oduncu M. Gossypiboma mistaken for a hydatid cyst: case report. Turk J Surg 2020; 36:405-408. [PMID: 33778401 DOI: 10.47717/turkjsurg.2020.3742] [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: 12/11/2016] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Although considered a rare complication, gossypiboma continues to be a clinically important and probably more frequently encountered than reported situation. This study aimed to report a case of gossypiboma that was mistaken for a hydatid cyst in the preoperative evaluation. A 34-year-old male patient with a history of Nissen Fundoplication presented with a large mass palpable in the epigastrium and both the left upper and lower quadrants of the abdomen. Computerized tomography was reported to show a 20x18 cm cystic mass with a collapsed germinative membrane inside it. Laparotomy, which was performed with a suggested diagnosis of type 3 hydatid cyst, revealed that the mass was caused by a 30x30 cm surgical abdominal compress. We believe gossypiboma should be kept in mind in the differential diagnosis of abdominal hydatid cysts in the presence of a former abdominal operation, especially when the result of indirect hemagglutination test is negative.
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Affiliation(s)
| | - Rıza Haldun Gündoğdu
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | | | - Soner Akbaba
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mehmet Oduncu
- Clinic of General Surgery, Samandağ Güneypark Hospital, Hatay, Turkey
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Tchangai B, Tchaou M, Kassegne I, Simlawo K. Incidence, root cause, and outcomes of unintentionally retained intraabdominal surgical sponges: a retrospective case series from two hospitals in Togo. Patient Saf Surg 2017; 11:25. [PMID: 29090018 PMCID: PMC5657063 DOI: 10.1186/s13037-017-0140-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/13/2017] [Indexed: 12/23/2022] Open
Abstract
Background The term gossypiboma refers to a sponge that has been forgotten in the surgical field. It is the most common retained surgical item, and constitutes a continuing problem for surgical safety. We performed a hospital-based study to examine their incidence, root cause, and outcomes, as an effort toward improving prevention. Methods This retrospective study covered 10 years (2006-2015) and included surgically confirmed cases of abdominal gossypibomas occurring after 45,011 abdominal and gynaecological operations in 2 public hospitals in Lome (Togo). Age, diagnosis, initial surgical procedure, evidence of textile count, and data related to the revision procedure were collected for descriptive analysis. Results Fifteen cases of gossypibomas (11 women and 4 men) were recorded. The mean age of the patients was 27 (range 21-55) years. Initial procedures were gynaecological in 11 patients and 5 cases involved an emergency surgery. Evidence of sponge counting was found in 6cases. Gossypiboma was an incidental finding in 1 patient. The average time to onset of symptoms after the initial procedure was 2 months. The gossypiboma was removed within 7 days to 4 years after the initial procedure. Postoperative complications included enterocutaneous fistula in 2 patients, incisional hernia in 2 patients, and wound sepsis in 1 patient. Death occurred in 2 patients (13.3%). Conclusions Although rare, the incidence of gossypibomas is still unacceptably high and reveals failures regarding patient safety standards. The associated morbidity and mortality are significant, yet can be reduced by an early diagnosis in the immediate postoperative period. A systematic methodical count of sponges is the cornerstone of prevention, and introducing surgical safety protocols, such as the WHO Safe Surgery Saves Lives checklist, can enhance effectiveness. There is a crucial need for safety-focused policies, which may include a never event reporting system, elaboration of prevention strategies, interventions, and evaluation.
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Affiliation(s)
- Boyodi Tchangai
- Department of Surgery, Teaching Hospital of Sylvanus Olympio, Lomé, Togo.,Visceral surgeon at Sylvanus Olympio Teaching Hospital, 198 rue de la santé, P.O Box 57, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Radiology, Teaching Hospital of Sylvanus Olympio, Lomé, Togo
| | - Iroukora Kassegne
- Department of Surgery, Teaching Hospital of Sylvanus Olympio, Lomé, Togo
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Mathew RP, Thomas B, Basti RS, Suresh HB. Gossypibomas, a surgeon's nightmare-patient demographics, risk factors, imaging and how we can prevent it. Br J Radiol 2017; 90:20160761. [PMID: 27885854 DOI: 10.1259/bjr.20160761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Gossypibomas are a cottonoid matrix left behind following surgery. Owing to the legal issues associated with it, very few literature studies are available online, most of them being case reports. The purpose of our study was to identify the patient demographics, risk factors and imaging features. METHODS Six surgically identified and histopathologically confirmed cases of gossypibomas recorded over a period of 5 years from a single tertiary institution were retrospectively evaluated for patient demographics [sex, age, body mass index (BMI)], type of surgery and duration from time of surgery to onset of symptoms. Ultrasound and CT images obtained from our hospital database were evaluated for their characteristic pattern. Statistics used included percentage and frequency. RESULTS Females formed the bulk of our patients and the mean BMI of our patients was 24.25. The interval between surgery and symptom presentation ranged from 2 months to 7 years. The most common imaging patterns observed on ultrasound and CT were a thick-walled hypoechoic lesion with a strong posterior acoustic shadowing and a "spongiform pattern", respectively. CONCLUSION A detailed patient history, taking into account radiologist-surgeon interaction, along with familiarization of the various risk factors and imaging patterns can bring about an accurate diagnosis of a gossypiboma. Advances in knowledge: Our study showed that the female sex, especially those undergoing gynaecology-related surgery such as hysterectomy and patients with a high BMI were at risk of gossypibomas. The combination of a hypoechoic lesion with strong posterior shadowing on ultrasound along with a spongiform pattern on CT was highly characteristic for gossypiboma on imaging.
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Affiliation(s)
- Rishi P Mathew
- 1 Department of Radiology, KG Hospital and Post Graduate Medical Institute, Coimbatore, India
| | - Binston Thomas
- 2 Department of Radiology, Kerala Institute of Medical Sciences, Kottayam, Kerala, India
| | - Ram S Basti
- 3 Department of Radio-diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
| | - Hadihally B Suresh
- 3 Department of Radio-diagnosis, Father Muller Medical College, Mangalore, Karnataka, India
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Ma GW, Yuen A, Vlachou PA, de Montbrun S. An unconventional therapeutic approach to a migratory IUD causing perforation of the rectum. J Surg Case Rep 2016; 2016:rjw004. [PMID: 26838305 PMCID: PMC4735707 DOI: 10.1093/jscr/rjw004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Intrauterine devices (IUDs) are a commonly used form of contraception. The risk of perforation and migration of these devices have been reported to be 1 in 1000. Migration into the rectum is even more uncommon. The following case illustrates a previously healthy 37-year-old woman who experienced a perforation and migration of an IUD into the rectum necessitating endoscopic removal. To our knowledge, this complication of IUD and subsequent endoscopic removal has not been previously described and presents a viable first-line therapeutic option in a stable patient.
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Affiliation(s)
- Grace W Ma
- Department of General Surgery, University of Toronto, Canada Mount Sinai Hospital, Toronto, Canada
| | - Andrew Yuen
- Department of General Surgery, University of Toronto, Canada
| | - Paraskevi A Vlachou
- St Michael's Hospital, Toronto, Canada Department of Medical Imaging, University of Toronto, Canada
| | - Sandra de Montbrun
- Department of General Surgery, University of Toronto, Canada St Michael's Hospital, Toronto, Canada
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Rabie ME, Hosni MH, Al Safty A, Al Jarallah M, Ghaleb FH. Gossypiboma revisited: A never ending issue. Int J Surg Case Rep 2015; 19:87-91. [PMID: 26741272 PMCID: PMC4756180 DOI: 10.1016/j.ijscr.2015.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
Abstract
Retained foreign objects (RFO), is one of the most dreadful complications of surgery. Despite a seemingly correct count, laparotomy pads were missed at the end of surgery in three patients. Human errors continue to occur and RFO continues to plague the surgical practice. To avoid human error, one of several recent technologies designed to check for items left behind, should be employed. In our report, we give an important tip on how to extract the retained surgical sponge without causing much damage.
Introduction Leaving a surgical item inside the patient at the end of surgery, is one of the most dreadful complications. The item is frequently a surgical sponge and the resultant morbidity is usually severe. Additionally, the event poses considerable psychic strain to the operating team, notably the surgeon. Presentation of cases Here we describe the clinical course of three patients in whom a surgical sponge was missed, despite a seemingly correct count at the end of difficult caesarean sections. In two patients, who presented shortly after surgery, the pad was extracted with no bowel resection. In the third patient, who presented several years after surgery, colectomy was performed. Discussion Gossypiboma is under reported and the true incidence is largely unknown. Depending on the body reaction and the characters of the retained sponge, the patient may present within months to years after surgery. Risk factors for retained foreign objects include emergency surgery, an unplanned change in the surgical procedure, higher body mass index, multiple surgical teams, greater number of major procedures done at the same time and incorrect count recording. The surgical procedure needed to extract the retained sponge may be a simple one, as in the first case, or it may be more complex, as seen in the other two cases. Although holding the correct count at the end of surgery is the gold standard safeguard against this mishap, human errors continue to occur, as happened in our patients. For that reason, the correct count should be supplemented by employing one of the several new technologies currently available. Conclusion Gossypiboma continues to occur, despite precautionary measures. As its consequences might cost the patient his life and the surgeon his professional reputation, extra preventive measures should be sought and implemented. New advances in technology should be incorporated in the theatre protocol as additional safeguard against human error. When encountered, a direct incision over the encapsulated swelling, in contrast to a formal laparotomy incision, might simplify the surgical procedure.
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Affiliation(s)
- M Ezzedien Rabie
- Department of Surgery, Aseer Central Hospital-Abha, Saudi Arabia.
| | | | - Alaa Al Safty
- Department of Surgery, Aseer Central Hospital-Abha, Saudi Arabia
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Sozutek A, Colak T, Reyhan E, Turkmenoglu O, Akpınar E. Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication. Indian J Surg 2015; 77:1295-300. [PMID: 27011554 DOI: 10.1007/s12262-015-1280-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intra-abdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosis-prior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4 ± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.
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Affiliation(s)
- Alper Sozutek
- Department of Gastroenterological Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Tahsin Colak
- Department of General Surgery, Mersin University Medical Faculty, Mersin, Turkey
| | - Enver Reyhan
- Department of Gastroenterological Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ozgur Turkmenoglu
- Department of General Surgery, Mersin University Medical Faculty, Mersin, Turkey
| | - Edip Akpınar
- Department of Gastroenterological Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
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Henriques AC, Segre JM, Silva PA, Ide E, Godinho CA, Waisberg J. Endoscopic removal of foreign body abandoned in prior laparotomy. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:310-1. [PMID: 25626950 PMCID: PMC4743233 DOI: 10.1590/s0102-67202014000400023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Edson Ide
- Faculdade de Medicina do ABC, São Bernardo do Campo, SP, Brazil
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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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Abstract
Gossypiboma, a retained surgical sponge, is a rare complication that can occur after any type of surgery. Despite the precautions, the retention of foreign bodies still occurs. We describe a case of a 33-year-old woman with epigastric pain. She was initially diagnosed with acute cholangitis with choledocholithiasis. Although common bile duct stone was successfully removed endoscopically, her epigastric pain did not completely subside. She had undergone an emergency caesarean section at a suburban maternity hospital 6 weeks prior to the referral. A contrast-enhanced CT revealed an encapsulated mass showing a spongiform pattern with fluids and gas bubbles inside, and gossypiboma was suspected. A retained surgical sponge without radiopaque markers was removed surgically. Except for a wound infection, the postoperative course was uneventful. Gossypiboma should always be considered in the differential diagnosis of indeterminate abdominal pain, infection or a mass in patients with a prior surgical history.
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12
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Extrahepatic textiloma long misdiagnosed as calcified echinococcal cyst. Case Rep Gastrointest Med 2013; 2013:261685. [PMID: 23533840 PMCID: PMC3600324 DOI: 10.1155/2013/261685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/29/2013] [Indexed: 12/28/2022] Open
Abstract
Textiloma or gossypiboma is a retained surgical swab in the body after an operation and is a complication that can remain undetected for many years and may represent a diagnostic dilemma depending on its location. It may be confused with several focal lesions and an accurate history taking, combined with clinical and instrumental data, is key to suspecting the diagnosis. We report a case of abdominal textiloma that was initially misdiagnosed as echinococcal cyst and discuss the differential diagnosis based on sonographic features and the WHO-IWGE classification.
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Abstract
Gossypiboma or a retained surgical sponge is a rare but avoidable surgical complication. It leads to considerable morbidity and at times even mortality. We report a case of a 24-year-old lady who presented one month after a Caesarean operation with complaints of fever, pain in abdomen, and vomiting. After the clinical examination a possibility of a retained surgical sponge was entertained. However a CT scan of abdomen revealed the complete diagnosis and helped in treating the patient surgically with a successful outcome. A review of the literature and all the relevant issues in the management of such a case have been discussed.
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Affiliation(s)
- Abdul Haque M. Quraishi
- Department of Surgery, Government Medical College, 22, Vijaynagar, Chhaoni, Nagpur 440013, India
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14
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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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15
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Gossypiboma: retained surgical sponge after a gynecologic procedure. Case Rep Med 2010; 2010. [PMID: 20811606 PMCID: PMC2929520 DOI: 10.1155/2010/917626] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 05/03/2010] [Accepted: 07/08/2010] [Indexed: 11/24/2022] Open
Abstract
We report on a case of gossypiboma. A 54-year-old woman was admitted to our hospital with abdominal mass. She had undergone a caesarean operation 23 years previously. The mass in the right abdominal quadrant was suspected by abdominal computed tomography and magnetic resonance imaging. The mass was removed by laparotomy excision and the final diagnosis was gossypiboma.
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Sakorafas GH, Sampanis D, Lappas C, Papantoni E, Christodoulou S, Mastoraki A, Safioleas M. Retained surgical sponges: what the practicing clinician should know. Langenbecks Arch Surg 2010; 395:1001-7. [PMID: 20652587 DOI: 10.1007/s00423-010-0684-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/01/2010] [Indexed: 01/02/2023]
Abstract
Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, ATTIKON U. Hospital, Arkadias 19-21, 115 26, Athens, Greece.
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17
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Govarjin HM, Talebianfar M, Fattahi F, Akbari ME. Textiloma, migration of retained long gauze from abdominal cavity to intestine. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2010; 15:54-7. [PMID: 21526059 PMCID: PMC3082787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 07/14/2009] [Indexed: 10/25/2022]
Abstract
Retaining of gauzes and surgical sponges in the abdomen is one of the most frequent medical errors usually manifesting as abscess or abdominocutaneus fistulas with no definite symptoms during lifetime. Here, we introduce a 35 year old woman with symptoms and signs of partial bowel obstruction and enterocutaneous fistulas caused by migration of retained gauze from abdominal cavity to terminal ileum, 9 months after cesarean section. This is called "Textiloma". There are several reports of gossypiboma worldwide but migration of retained gauze into intestine causing an enterocutaneous fistula is rare.
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Affiliation(s)
- Hojjat Molaei Govarjin
- Department of General Surgery, Shohada Teaching Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Mohsen Talebianfar
- Department of General Surgery, Shohada Teaching Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Farinaz Fattahi
- Cancer Research Center, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Mohammad Esmaeil Akbari
- Cancer Research Center, Shahid Beheshti University Of Medical Sciences, Tehran, Iran,Professor of Surgery, Shahid Beheshti University Of Medical Sciences, Tehran, Iran,* Corresponding Author E-mail:
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18
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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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