Computed tomography of a canine omental torsion secondary to a chronic abdominal gossypiboma and concurrent incidental broad ligament torsion

A 5-year-old female spayed Dogue de Bordeaux was referred for concerns of an abdominal mass and peritoneal effusion. Abdominal radiographs identified a mid-ventral abdominal soft tissue opaque mass containing a radiopaque marker consistent with a gossypiboma. Contrast-enhanced abdominal CT identified two whirl signs associated with the abdominal gossypiboma. Exploratory laparotomy confirmed an omental torsion with encapsulated gossypiboma and concurrent incidental torsion of the remnant of the right broad ligament. Based on a literature review, omental torsions are an unreported complication of gossypibomas in canids.

Fortuitous Eradication of an Aggressive Basal Cell Carcinoma Via Foreign Body Reaction to a Polyurethane Vacuum-Assisted Closure Sponge

ABSTRACT

The foreign body reaction (FBR) is a well-documented immune reaction. Much of the literature on FBRs has focused on minimizing this immune response to mitigate the impact on medical implants. Here, we present a case that illustrates a serendipitous oncologic outcome from an FBR. A 54-year-old man presented with an aggressive basal cell carcinoma (BCC). At the first resection, he had broadly positive surgical margins. The surgical wound was temporized with a polyurethane wound vacuum assisted closure (VAC) device. He was lost to follow-up having retained a VAC sponge for a total of 12 weeks. A wide re-resection was performed 7 months after the initial resection. Exhaustive examination of the resected specimen was performed. There was an absence of any BCC, replaced by a widespread chronic FBR to polyurethane VAC sponge particles. This suggests that the foreign body immune response was sufficiently intense to eradicate any remaining BCC. This case illustrates the concept of an FBR as a novel method of local immunotherapy.

Gossypiboma: a ghastly find

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.

Retained Surgical Gauze Presenting With Gross Hematuria: A Case Report

Gossipyboma is a mass which is made around a cotton sponge or abdominal compress retained in a patient during surgery accidentally. Patients manifest with either acute or chronic symptoms due to complications. Here in wereported an 89-year-old man case of transvesical migration of gossipyboma who presented with gross hematuria with a history of transvesical prostatectomy 6 years ago. Patient underwent exploratory laparotomy with repairing of the bladder and peritoneum. He had no complications during surgery and was subsequently discharged.

A Retained Sponge Is a Complication of Vacuum-Assisted Closure Therapy™

Vacuum-assisted closure (VAC) system has become a widely used, efficacious, and overall safe method for managing many types of open wounds. The authors present a case of a rare but avoidable complication caused by a retained piece of sponge after VAC therapy™ (KCI Inc, San Antonio, TX). They emphasize the need for awareness and careful evaluation of the patient who receives VAC therapy to avoid diagnostic confusion and morbidity to the patient.

Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy

Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications.

Which type of reaction in retained surgical sponge is more dangerous?

BACKGROUND

Retained surgical sponge is a term to define forgotten surgical sponges during operation. RSS causes two kinds of reactions in the body. The first one is to develop an abscess through exudative inflammatory reaction in early phases and second one is to form a mass through aseptic inflammatory reaction which can stay asymptomatic for months, even for years. In this study we aimed to investigate the time of hospital admission, type of reaction and effect of need for bowel resection on prognosis in patients with retained surgical sponge.

METHODS

In the study, we scanned the files of 18 patients with retained surgical sponge who had been operated at Dicle University Medical Faculty General Surgery Clinic between January 1994 and July 2012, retrospectively.

RESULTS

Need for intestine resection was higher in patients who were operated in the early phase (p:0.034). Morbidity and duration of hospital stay were significantly higher (respectively P:0.02, P:0.007) in patients who had underwent intestine resection.

CONCLUSION

In patients with retained surgical sponge, need for intestine resection is increased due to exudative reaction in the early phase. This increase is giving rise to morbidity rates and prolonged hospital stay.

KEY WORDS

Morbidity, Retained surgical sponge.

A case of gossypiboma mimicking intrahepatic cholangiocarcinoma

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.

Sonographic diagnosis of abscess following breast-conserving surgery with insertion of nonabsorbable mesh

Immediate mesh insertion has been recently used for breast reconstruction after breast-conserving surgery. We report a case of abscess formation following immediate nonabsorbable mesh insertion with breast-conserving surgery. In this article, we demonstrate multimodal breast imaging features and pathologic correlations of the case. In addition, we illustrate characteristic sonographic findings of nonabsorbable mesh fibers to differentiate them from a gossypiboma caused by a retained surgical sponge or tumor recurrence.

Colonic perforation by a transmural and transvalvular migrated retained sponge: Multi-detector computed tomography findings

Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction. Once passed through the ileo-cecal valve, a retained sponge can be propelled forward by peristaltic activity and eliminated with feces. We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation. On physical examination, a generalized resistance was observed with tenderness in the right flank. Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery. In addition, a ring-shaped hyperdense intraluminal material was also noted. At surgery, the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure, but no diverticula were found. A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.

[Postoperative intra-abdominal foreign body resemblance to neoplasm. Report of a case and review of the bibliography]

INTRODUCTION

Gossypibomas or textilomas are materials remain in the abdomen after surgery. It is very difficult to assess its impact due to medico-legal implications, hence the interest in the publication of this type of pathology.

CLINICAL CASE

Women of 76 years who had undergone a hysterectomy and double anexectomy 6 months before admission to our hospital, apparently without perioperative complications. When she was assessed in our hospital she had a clinical picture simulating a malignancy. In our case, the patient had signs and symptoms of advanced intra-abdominal malignancy, such as chronic anemia, significant weight loss and palpable abdominal mass. The diagnostic procedure combined computed tomography and colonoscopy, aiming to find the signs of intra-abdominal gossypiboma. Three bowel resections were performed to extract the foreign body, with satisfactory postoperative results and remaining asymptomatic to date.

CONCLUSION

Intra-abdominal gossypibomas are exceptional, although the diagnosis is made through imaging and, if suspected GI neoplasm, endoscopic studies. The primary differential diagnosis must be made with intra-abdominal malignancies.

Paraspinal textiloma after posterior lumbar surgery: a wolf in sheep's clothing

OBJECTIVE

Paraspinal textiloma (ParaTex) is a well-known complication after posterior lumbar surgery. However, there are few articles on this topic, probably because of medicolegal concerns. In addition, patients with ParaTex can remain asymptomatic for months or even years unless it causes complications. The purpose of this study is to review our experience on this "undesirable" topic to increase awareness among spinal surgeons and radiologists and avoid unnecessary morbidity, which is still being encountered.

METHODS

This study is a retrospective case series of six patients with ParaTex who underwent posterior lumbar spinal surgery in our neurosurgical department between January 2000 and December 2010. The medical records of each patient were reviewed and demographic data, clinical characteristics, initial diagnosis, surgical procedures, time interval between operation and onset of symptoms, biological and radiologic findings, treatment, and outcome were analyzed.

RESULTS

The six patients included four women and two men with a mean age of 48 years. Four patients had a history of lumbar disc herniation, one had undergone a laminectomy for a lumbar spinal stenosis, and a Gill's procedure was performed in one patient with a lumbar spondylolisthesis. The time from the causative operation to presentation ranged from 2 months to 6 years. All patients presented with nonspecific lower back pain and/or surgical site infection without fever or neurological symptoms. Laboratory parameters showed increased blood sedimentation rates and/or C-reactive protein level in four patients. Bacteria were isolated in only one patient. Five patients were evaluated with computed tomography scan, and this showed the spongiform pattern with gas bubbles in three cases. Magnetic resonance imaging was performed in two patients. The signal intensity varies according to stage and fluid content of the lesion. The ParaTex was removed surgically in all patients with a good outcome.

CONCLUSIONS

ParaTexs are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure. On computed tomography scan, the classic spongiform appearance is highly suggestive. Magnetic resonance imaging findings are variable and less specific, but confrontation of imaging data with the surgical history helps with the preoperative diagnosis. In the early postoperative period symptoms are related to the exudative response; at later times symptoms may be linked to pseudotumor formation clinically and radiologically. Appropriate antibiotic therapy is recommended when a septic complication is present or suspected. Strict measures must be taken to prevent this complication. Surgical sponges should always be counted at least three times (preoperatively, at closure, and at the end), radiopaque markers should be used, and if there is doubt, intraoperative radiography must be performed.

Textiloma as a complication of transsphenoidal surgery

Transsphenoidal surgery is the mainstream in the management of sellar and anterior fossa diseases. However, textiloma, as known as cotton left behind during an operation, is rarely reported as a complication of transsphenoidal surgery. In this paper, we present a case of textiloma after transsphenoidal surgery. The patient had been suffering progressive blurred vision and she received transsphenoidal surgery for the diagnosis of pituitary tumor. However, the intermittent headaches persisted for half a year after the surgery. The subsequent images revealed a rim-like enhanced tumor in the sellar region. The retained cotton material was found when she underwent transcranial surgery. The etiology and management of textiloma are discussed, and the relevant literature also reviewed.

[18-FDG PET-scan of intrathoracic gossypiboma during the monitoring of lung cancer]

The 18-FDG PET-scan is today used to monitor patients operated for non small-cell lung cancer. The presence of an intrathoracic gossypiboma (or textiloma) can be responsible for intense enhancement in a PET-scan because of inflammatory phenomenon. The authors report the case of a patient who underwent surgery for lung cancer nine years ago, where a newly discovered intrathoracic mass with intensive enhancement on PET-scan, led to concern about a local recurrence in spite of the fine-needle transthoracic biopsy identifying textile fibers in the histological examination.

[Gossypiboma--retained textile foreign body]

INTRODUCTION, HISTORY: Increasing complexity of modem surgery is accompanied by the emergence of very different possibility of errors; one of the oldest and most obvious errors is the foreign body forgotten inside the patient. Surgeons worldwide have reported this incident since the first record by Wilson in 1884.

DEFINITIONS

Over time, different terms have been used for retained textile foreign body (RTFB), with various etymologies, sometimes controversial: gossypiboma is the latest in this line.

EPIDEMIOLOGY

Various studies indicate the incidence of RTFB in range of 1:833-1:32.672; this expresses the difficulty to determine precisely due to complex causes. In our unit the incidence is 1:15.047. RTFB occur after operations on any cavity or organ (operations on the abdomen 56%, pelvis 18%, thorax 11%, orthopedic, neurosurgical, cardiovascular, etc.), at all ages and both sexes. DIAGNOSIS IS VARIABLE: from a loud postoperative evolution, with fever, suppuration of the wound, fistula tracks, spontaneous erosion into various hollow organs to a long asymptomatic period. Imaging diagnosis is difficult and requires RTFB inclusion in the differential diagnosis of patients with a history of surgery. Treatment involves a patient's informed consent and an adjustment to a case: removal of RTFB and individualized treatment of any associated injuries (abscess, fistulas, adhesions, remaining cavity, foci of bone lysis) or just monitoring.

PREVENTION

From the theory of "bad apple" (mistake of an incompetent doctor) we moved forward to address systems that often contain latent errors whose summation results in the unfortunate incident. Various national authorities have issued regulations to prevent RTFB, based on counting compresses, intra-/postoperative radiography, marking compresses with two-dimensional matrix label or radio frequency identification.

CONCLUSIONS

RTFB, no matter how exotic we name it, remains an unfortunate incident with serious consequences for patient and surgeon alike. The introduction of new technologies can help create a safer environment in the operating room, but beyond that the human factor implies the presence of variables difficult or impossible to control.

Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery

BACKGROUND

Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal surgery. The gentamicin-collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.

METHODS

In a phase 3 trial, we randomly assigned 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites to undergo either the insertion of two gentamicin-collagen sponges above the fascia at the time of surgical closure (the sponge group) or no intervention (the control group). All patients received standard care, including prophylactic systemic antibiotics. The primary end point was surgical-site infection occurring within 60 days after surgery, as adjudicated by a clinical-events classification committee that was unaware of the study-group assignments.

RESULTS

The incidence of surgical-site infection was higher in the sponge group (90 of 300 patients [30.0%]) than in the control group (63 of 302 patients [20.9%], P=0.01). Superficial surgical-site infection occurred in 20.3% of patients in the sponge group and 13.6% of patients in the control group (P=0.03), and deep surgical-site infection in 8.3% and 6.0% (P=0.26), respectively. Patients in the sponge group were more likely to visit an emergency room or surgeon's office owing to a wound-related sign or symptom (19.7%, vs. 11.0% in the control group; P=0.004) and to be rehospitalized for surgical-site infection (7.0% vs. 4.3%, P=0.15). The frequency of adverse events did not differ significantly between the two groups.

CONCLUSIONS

Our large, multicenter trial shows that the gentamicin-collagen sponge is not effective at preventing surgical-site infection in patients who undergo colorectal surgery; paradoxically, it appears to result in significantly more surgical-site infections. (Funded by Innocoll Technologies; ClinicalTrials.gov number, NCT00600925.)

Intra-abdominal gossypiboma: a report of two cases and a review of literature

Post operative foreign body in the abdominal cavily, though rare continues to occur in surgical practice. Symptoms may start early with abdominal pain but usually have a varying course, ofter leading 10 the formation of gossypiboma. This is usually a great source of embarrassment to the surgeon and the centre, and of serious detrimental effect to the patient. A case report of a 27-year-old trader with intra-abdominal foreign body is presented to highlig at the similarity in presentation with abdominal lymphoma and the need to explore carefully masses in the abdominal cavity especially in patients who have had surgery in the past. A high index of suspicious is required on the part of the clinician in addition to appropriate radiological and sonologic assessment. Prompt diagnosis and treatment ameliorates the patients suffering and brings them back to life.

After 40 years gossypiboma caused spleen abscess

We report a case of spleen abscess cased by foreign body (gossypiboma) after 40 years. After physical examination, laboratory, ultrasonography and CT findings with diagnosis of acute abdomen, 73 years old woman had undergone laparatomy. Operation revealed intraabdominal spleen abscess. Capsulotomy and drainage of the collection was performed before splenectomy. Histological examination showed foreign body material surrounded by chronic inflammation, foreign body-type multinucleated giant cells, extravasated red blood cells and fibroblastic proliferation. From anamnesis we found that woman was operated only once during a life with diagnosis of extrauterine pregnancy, 40 years ago. Spleen abscess caused by gossypiboma after 40 years was never described before. However, diagnosis like this is very well known but rarely published because medical-legal implication. Education, professionalism and cooperation of all persons involved in surgical procedure are very important to prevent accidentally mistakes.

Clinical, pathological and radiological features of paraspinal textiloma: report of two cases and review of the literature

Textiloma is a term used for retained cottonoid or surgical sponge in the operation field. Although they occur mostly after thoracic or abdominal operation, they can also be encountered after surgery of extremities or the spine. There are few reports of spinal cases in which MR and CT imaging findings of textilomas have been described. In this report, two additional cases with MR, CT and pathological features of paraspinal textilomas are described. CT image demonstrated a paraspinal mass simulating a malignant tumour. While T1-weighted MR images showed the masses with low signal intensity, T2-weighted MR images showed heterogeneous masses with low and high signal intensities.

Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness

BACKGROUND

New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges.

METHODS

Key model parameters were obtained from field observations during a randomized-controlled BCS trial (n = 298), an observational study of RSS (n = 191,168), and clinical experience with BCS (n approximately 60,000). Because no comparable data exist for RF, we modeled its performance under 2 alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision maker's perspective.

RESULTS

Standard counting detects 82% of RSS. Bar coding prevents > or =97.5% for an additional $95,000 per RSS averted. If RF were as effective as bar coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal and selective x-rays for high-risk operations are more costly, but less effective than BCS-$1.1 to 1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost.

CONCLUSION

Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly "never events." Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.

Intraluminal migration of Gossypiboma without intestinal obstruction for fourteen years

A 55 years lady presented with dull aching right upper abdominal pain with intermittent episodes of diarrhea following cholecystectomy which she underwent fourteen years back. Ultrasound and computed tomography findings were suggestive of foreign body in right subhepatic space. Exploratory laparotomy revealed circumvented loop of ileum with intra luminal mass sized 5 x 10 cm, resection anastomosis of the segment of ileum was performed. When opened it contained a surgical sponge with no external communication but an internal fistulous tract was present between the proximal and distal loops beyond the mass. Though intraluminal migration of retained surgical sponge has often been reported, complete intraluminal migration without features of obstruction or external opening is rarely seen.

A misplaced surgical towel - a rare cause of fever of unknown origin

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.

Textiloma complicated by abscess-formation, three years after surgical repair of abdominal aortic aneurysm

This report deals with a late complication of open surgery for inflammatory abdominal aortic aneurysm. A surgical sponge was retained and three years later, the patient presented with acute onset of back pain. Radiological evaluation by means of abdominal plain film and CT-scan, respectively revealed metallic wires projecting in the left hypochondrium and a rounded hypodense mass-lesion located retroperitoneally above the left kidney, containing the metallic wires and presenting with a contrast-enhancing peripheral rim, corresponding to abscess-formation around the retained sponge. The patient was treated by surgical retrieval of the sponge and drainage of the abscess. The aim of this report is to highlight the importance of both abdominal plain film and CT-scan in the detection of a potential textiloma after aortic surgery, even in case of late clinical presentation.

Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus

A 55-year-old hemiplegic woman with percutaneous endoscopic gastrostomy (PEG) was referred to our clinic for upper gastrointestinal system bleeding and for a high level of cholestatic enzymes. She had a medical history of cerebra vascular accident three years previously and cholecystectomy one year previously. We performed gastroscopy and saw a retained surgical sponge in the bulbus. After removal of the gossypiboma, endoscopic sclerotherapy was performed for the bleeding area at the bulbus. After the procedure, the upper gastrointestinal bleeding stopped and the high level of cholestatic enzymes returned to normal.

Gossypiboma--retained surgical sponge

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.

Iodoform intoxication; a case report of prolonged consciousness disturbance in a patient with a high plasma iodine level

This report describes a case in which a consciousness disturbance was associated with a high plasma iodine level and which improved after the removal of iodoform gauze that had been applied to infected wounds. A 71-year-old male with poorly controlled diabetes underwent a laminectomy for an epidural abscess. On the 6th and 8th postoperative days, he underwent debridement for fasciitis in the both arms and iodoform gauze was applied to the wounds (both arms and lumbar region) at the end of the first debridement and then changed every day. His consciousness then gradually deteriorated after the debridement. His plasma iodine level was measured and was shown to be remarkably high (6,280 microg/dl) 19 days after the laminectomy (13 days after the beginning of iodoform application). His consciousness recovered gradually with a concomitant decrease in the plasma iodine level. Three months after the removal of the iodoform he became almost alert. Caution should be exercised in using iodoform gauze because of the possibility that it could affect consciousness.

A retained surgical sponge presenting as chronic pelvic pain

BACKGROUND

Gossypiboma, the term for a retained sponge, is an underestimated occurrence related to gynecologic surgery. The postoperative presentation can be acute or subacute with symptoms that include pelvic pain.

CASE

A 39-year-old G7P3043 female presented with chronic pelvic pain. Her only past surgeries were 16 and 21 years prior. After failing to respond to conservative options, she was taken to the operating room for a hysterectomy and possible salpingoophorectomy. During the surgery, a retained sponge was found and removed. Postoperatively, the pain resolved completely.

CONCLUSION

Although gossypiboma is an uncommon cause of chronic pelvic pain, patients can present years later with minimal complications other than discomfort. Accurate sponge and instrument counts, along with radiologic evaluation when a discrepancy is found, can be helpful. Newer technologies are also being developed to help avoid this complication.

A rare cause of breast mass that mimics carcinoma: Foreign body reaction to amorphous surgical material

A breast mass caused by foreign body type granulomatous reaction to surgical material is a very rare lesion and may mimic carcinoma. Reported foreign materials have included suture materials, silicone, paraffin, gunpowder and carbon particles used for localization of a nonpalpable breast lesions. To our knowledge, a foreign body reaction to gauze sponge has not been reported previously. A 58-year-old woman who had an enlarging mass that mimicked breast carcinoma, due to foreign body reaction to gauze sponge is presented here, and relevant literature is reviewed.

An unusual abdominal mass: case report

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.