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Gossypiboma is an extremely rare adverse event occurring post-surgery, where surgical gauze is left within the body. If aseptically retained, it can lead to the formation of granulation tissue through chronic inflammation and adhesion with surrounding tissues, potentially persisting asymptomatically for many years. While diagnosis of this condition has been reported through various imaging modalities such as abdominal ultrasound and computed tomography, cases not presenting with typical findings are difficult for preoperative diagnosis, and instances where it is discovered postoperatively exist. Particularly when in contact with the gastrointestinal tract within the abdominal cavity, differentiation from submucosal tumors of the digestive tract becomes problematic. This report describes the imaging characteristics of endoscopic ultrasound and the usefulness of endoscopic ultrasound-fine-needle-aspiration for tissue diagnosis in the preoperative diagnosis of intra-abdominal gossypiboma.
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Cranial retained surgical sponges, known as "gossypiboma" or "textiloma", represent a rare but potentially severe complication following surgical procedures. While it is infrequent, it poses a significant risk, particularly in delicate surgical settings such as neurosurgery. The inadvertent retention of cotton balls or surgical gauzes may cause localized inflammation, infection, abscess, or neurologic sequelae. In the realm of neurosurgery, where precision is paramount, the occurrence of postoperative brain gossypibomas is particularly concerning. This case report contributes to the radiological literature by presenting a distinctive instance of postoperative brain gossypiboma. By delving into the radiological intricacies and potential contributing factors to the retention of surgical materials in neurosurgical procedures, our aim is to underscore the significance of a collaborative approach between neurosurgeons and radiologists for enhanced detection and prevention of such complication.
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Gossypiboma, a term used to describe a retained foreign body mass of cotton (sponge, abdominal mop or gauze) within the body after a surgical procedure, is an uncommon but serious surgical complication. It can manifest with various clinical presentations and often leads to delayed diagnosis and significant morbidity. This report highlights the need for a repeat exploration at the end of open abdominal surgeries as routine. The case presented is that of a young female who underwent open myomectomy in an outreach setting, and subsequently developed symptoms of an acute abdomen due to a retained abdominal mop seen at surgery. The abdominal mop seen at laparotomy had migrated transmurally and became trapped within the ileum and ileocecal junction. After removal of the intra-luminal abdominal mop and abdominal closure, she had post-operative malnutrition and anaemia that were corrected as she regained full recovery. The incidence of gossypiboma is believed to be underestimated in developing countries, and surgical sponges are the most frequently retained foreign bodies. Accurate estimates of the incidence are challenging due to socio-cultural impediments and fear of litigation. Prompt recognition and prevention of gossypiboma are crucial to avoid associated complications and improve patient outcomes.
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INTRODUCTION: This case report reports an unusual occurrence of gossypiboma, which refers to the accidental retention of surgical materials like sponges in the peritoneal cavity. The term is derived from "gossypium" (cotton) and "boma" (place of concealment). Its incidence varies with surgical type, posing diagnostic challenges due to nonspecific symptoms and equivocal imaging. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation. CASE PRESENTATION: A 37-year-old woman with ten previous pregnancies and an emergent caesarean section presented with abdominal pain. Examination and ultrasound suggested an ovarian cyst. During surgery, a 10 × 10 cm gauze-filled mass adherent to the ovary and jejunum was found. Postoperatively, she recovered well with no complications. The patient was treated with intravenous fluids and antibiotics for five days post-surgery and recovered without any complications. She was discharged from the hospital five days after the procedure. CONCLUSION: To the best of our knowledge, this is the first reported case of gossypiboma in Sudan in 2024, highlighting diagnostic challenges and the need for preventive protocols. Root cause analysis of accidents, enhanced training, application of advanced technologies and a collaborative culture in the operating room can prevent the occurrence of such incidents. This case underscores the importance of meticulous surgical protocols and continuous improvement in safety measures to prevent retained surgical items, ensuring patient safety and optimal outcomes.
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BACKGROUND: Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. MATERIALS AND METHODS: A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. RESULT: Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. CONCLUSION: A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations. Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.
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INTRODUCTION: Textiloma is a rare surgical complication. The location in the renal compartment is exceptional. The diagnosis can be difficult due to its rarity and the absence of clinical signs. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure. PRESENTATION OF CASE: We present a case report of a 71-year-old female patient with a high blood pressure under treatment. In this history, we noted a right nephrectomy by a lombotomy 6 years ago indicated for a mute kidney on a pyelo-ureteral junction syndrome and a drainage of a suppuration of this renal compartment a year after surgery. The patient was diagnosed with purulent discharge through the lombotomy site associated with lower back pain that had been present for 4 years. The patient then underwent an uro-CT scan which showed an oval formation of the right renal compartment suggestive of a textiloma. An exploratory right lombotomy was performed. And then the wetraction of the compresses followed by washing and closing had been done. The postoperative course was simple. DISCUSSION: The location in the renal compartment is exceptional. These may include compresses, surgical gauzes, sponges, cotton pads, etc. The inflammation caused by this foreign body will be responsible for an abscess in the event of infection. An evolution towards chronicity follows as long as the foreign body persists. Diagnosis and reoperation are often made during the same hospitalization period. Early imaging will help to make early diagnosis avoiding diagnostic wandering. The diagnosis was made late in our observation. However, the diagnosis can be difficult due to its rarity and the absence of clinical signs. CONCLUSION: Textiloma is a rare surgical complication. Renal localization, although rare, is "exceptional" of consequence. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure.
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BACKGROUND: Gossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy. CASE PRESENTATION: A 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient's breathing improved drastically post intervention. CONCLUSION: Gossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.
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Cuerpos Extraños , Laringe , Ruidos Respiratorios , Tapones Quirúrgicos de Gaza , Tomografía Computarizada por Rayos X , Traqueostomía , Humanos , Masculino , Ruidos Respiratorios/etiología , Adulto , Tapones Quirúrgicos de Gaza/efectos adversos , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Laringe/diagnóstico por imagen , Laringe/lesiones , Traqueostomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Accidentes de TránsitoRESUMEN
INTRODUCTION: Textilomas are an infrequent but well-known surgical complication. The authors report a series of cases to describe the frequency of abdominal textilomas, the circumstances in which they occur, their clinical and morphological characteristics, and their management, to contextualise these data, which may serve as a basis for preventive measures. SETTING AND METHOD: This was a monocentric, retrospective, descriptive study conducted over 10 years at a tertiary hospital. The circumstances of the initial intervention, the diagnosis, and the treatment of textiloma cases treated in the said centre were documented. RESULTS: Twenty-one (21) cases of abdominal textiloma were collected, with an annual frequency of 2.1 cases/year. The cases were predominantly female, with a female-to-male sex ratio of 1.62. The median age of the patients was 37 years. The initial operation was performed in a public facility in 80.95 % of cases. Myomectomy was the main indication (23.81 %). The time for signs to develop before consultation was 16.47 ± 8.82 days. Textiloma extraction was performed in an emergency in 61.90 % of cases. We noted morbidity (38.10 %) and mortality (9.52 %) in our patients. CONCLUSION: Textilomas are a rare surgical complication, albeit with a high morbidity and mortality rate. Their clinical polymorphism and the difficulties of diagnosis and management mean that prevention is of prime importance.
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This report describes a case of transmural migration of a gossypiboma from the peritoneum into the urinary bladder in a 4-year-old, female spayed, mixed-breed dog. The dog was presented on an emergency basis for complete urethral obstruction with radiographic evidence of urocystolithiasis. An exploratory laparotomy was performed and a 4-5 cm mass was identified which was confluent with the apex of the urinary bladder. The mass and bladder were exteriorized and isolated, and an apical, partial cystectomy was performed to remove the mass and gain access to the uroliths within the lumen of the bladder. A 4×4 surgical sponge was identified within the trigone of the bladder, it had multiple uroliths; another sponge was also found within the mass itself. This case demonstrates an atypical cause of urethral obstruction and serves as the first reported case of transmural migration of a gossypiboma into the urinary bladder of a dog. It also illustrates the importance of establishing routine operating procedures including gauze counts and the use of radiopaque-labeled surgical gauze.
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Textiloma, also known as gossypiboma, is a rare but well-documented entity. It involves the omission of surgical material during surgery. Gossypiboma remains a diagnostic dilemma to this day, due to its wide spectrum of clinical symptoms and numerous radiological pitfalls. The recommended treatment for gossypiboma is surgical removal. Endoscopic removal has been performed by some teams and has shown satisfying results. We report the case of a 33-year-old woman with a transgastric migrating gossypiboma, managed by an endoscopic extraction.
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gossypiboma is used to describe a retained surgical swab in the body after an operation. It remains an unwanted complication of surgical practice that increase morbidity and mortality of the patient and profound medico legal problems. Intra-abdominal gossypiboma can migrate in to the ileum, stomach, colon or bladder without any apparent opening in the wall of these luminal organs. Vigilant sponge counting during procedures and thorough exploration prior to closure of the abdomen, are essential practices to avoid such occurrences. Herein we present a case of gossypiboma in a 26-year old woman that was in the lumen of small bowel and caused acute intestinal obstruction.
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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.
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Enfermedades de los Perros , Cuerpos Extraños , Epiplón , Tomografía Computarizada por Rayos X , Anomalía Torsional , Perros , Animales , Femenino , Anomalía Torsional/veterinaria , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía , Anomalía Torsional/etiología , Enfermedades de los Perros/etiología , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/cirugía , Enfermedades de los Perros/diagnóstico , Epiplón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/veterinaria , Cuerpos Extraños/veterinaria , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Enfermedades Peritoneales/veterinaria , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/etiología , Enfermedades Peritoneales/cirugía , Ligamento Ancho/diagnóstico por imagen , Tapones Quirúrgicos de Gaza/efectos adversos , Tapones Quirúrgicos de Gaza/veterinariaRESUMEN
Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe this condition. We present a case of a 40-cm-long retained surgical sponge in a 43-year-old woman who presented with unexplained chronic abdominal pain for several years. She had a history of open cholecystectomy, hepaticojejunostomy, and enteroenterostomy. Computed tomography scan revealed a large cotton sponge anchored within the large bowel. Surgical exploration is usually required for the retrieval of gossypiboma. However, it was successfully removed endoscopically using a diathermic needle knife with no immediate complications. The patient was discharged after 48 hours with marked improvement in her abdominal pain. This case emphasizes the emerging role of novel endoscopic interventions, resulting in excellent clinical outcomes, avoiding major surgical interventions, and providing cost-effective benefits.
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INTRODUCTION: Retained wound swabs although classified as a 'never event' and well documented in many surgical specialties are uncommon in spinal surgery. The aim of this article is to highlight the perioperative circumstances of an incident of a retained surgical swab and present a prevention protocol, in an attempt to eliminate its incidence. CASE REPORT: The perioperative management of a 53-year-old male undergoing spinal surgery in whom a surgical swab was retained is reported. In addition to existing safety procedures such as the World Health Organization checklist, a Retained Surgical Swab-Prevention Protocol was implemented in our hospital and is presented to eliminate the occurrence of this 'never event' occurring again. CONCLUSION: Retained surgical swabs or instruments are rare in spinal surgery occurring mostly in the lumbar spine, during emergency and prolonged procedures in patients with high body mass index. Maintaining a high index of suspicion and utilising a prevention protocol will prevent further harm to the patient.
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Procedimientos Neuroquirúrgicos , Complicaciones Posoperatorias , Masculino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Vértebras Lumbares/cirugía , Errores Médicos/prevención & controlRESUMEN
Introduction: Intra-abdominal gossypiboma, a cotton-based retained foreign body after an abdominal surgery, is associated with various clinical manifestations and complications. Its infrequent occurrence and unpredictability make its early diagnosis particularly challenging. We herein present an atypical case of intra-abdominal gossypiboma mistaken for a jejunal tumor. Case presentation: A 33-year-old female presented to the emergency room with an acute episode of progressive abdominal pain and distention, nausea, and vomiting for 20 hours. She had undergone an urgent cesarean section due to fetal tachycardia seven years prior. The initial diagnosis of small bowel obstruction (SBO) due to a jejunal tumor was established by computed tomography. Subsequent to successful medical management of the SBO, a laparoscopy-assisted resection of the mass and the adherent jejunal segment was conducted, culminating in a primary side-to-side jejunojejunostomy. Examination of the excised tissue revealed an approximately spherical fibrous mass, 6 × 6 × 5 cm in dimension, embedded in the jejunal wall, housing a 20 × 20-cm gauze. Postoperative recovery and routine follow-up ensued without complications. Conclusion: In light of this case, the need for clinicians to maintain an elevated awareness and suspicion of gossypiboma should be accentuated when evaluating an intra-abdominal mass, especially in patients with a prior history of high-risk laparotomy. Laparoscopic surgery stands out as a technically proficient and minimally invasive strategy for diagnosing and treating intra-abdominal gossypiboma. Besides, it is imperative to emphasize the importance of meticulous surgical procedures and postoperative protocols to prevent such oversights, reaffirming the need for consistent intraoperative counts and checks of surgical items.
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Introduction: Today, surgical errors are becoming less and less frequent, thanks to the development of new techniques and the choice of different approaches. Nevertheless, they are still possible, and it is important to mention them in order to prevent them and avoid their recurrence. Case Presentation: We report a case of intravesical textiloma, rarely observed in urological surgery, in an 80-year-old patient who underwent laparoscopic inguinal hernia repair and presented to a urological consultation with hematuria and irritative lower urinary tract signs. Abdominal ultrasound revealed a hyperechoic tissue-like formation in the posterior wall of the bladder. The diagnosis of a bladder tumor was therefore raised, and cystoscopy was performed, which revealed an intravesical textiloma. All foreign bodies were removed endoscopically, and the patient had a good post-operative outcome. Conclusion: The rarity of the urological location of textilomas and the importance of their prevention remain a goal in surgery, whatever the specialty.
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Introduction and importance: Retained surgical items are an uncommon complication for surgical operations, with an estimated incidence of 1 in 5500 to 1 in 18 000 operations. Retained surgical sponges are the most common retained surgical items, accounting for nearly 70%. In 1884, Wilson reported the first retained foreign body after laparotomy. Case presentation: A 22-year-old woman was referred to our hospital complaining of a feeling of abdominal bloating and heaviness associated with pain, fever, fatigue, and severe stink vaginal discharges. Past surgical history included a cesarean section followed by laparotomy to remove a foreign body left behind; the obstetrician denied the presence of any foreign body. The diagnosis of retained surgical sponges was done in our hospital, according to the clinical history and radiographic study. The second laparotomy was performed, and the surgical sponge was removed. Clinical discussion: Retained surgical items' symptoms vary according to the site and types of materials. The diagnosis may be difficult because it resembles benign or malignant soft-tissue tumors of the abdomen and pelvis. Ultrasound and computed tomography have been used for the diagnosis of retained surgical items. The minimally invasive surgical approach appears to be most successful if the object is located early in the postoperative course. Conclusion: Retained surgical items are serious problems of surgical operations and should be among the differential diagnosis of any abdominal pain in patients with a history of prior surgery.
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Gossypiboma is a rare post-surgical complication comprising a retained surgical gauze surrounded by a foreign body reaction. Although usually presenting on magnetic resonance imaging (MRI) with low T1 signal, high central and low peripheral signal on T2, and bandlike peripheral enhancement, MR appearance is often non-specific. The barium sulphate filament within a surgical gauze presents on MR as a curvilinear thread which is dark on both T1 and T2 sequences. Scrutinizing the MR images is critical to identify the filament and to pinpoint the diagnosis of gossypiboma. Teaching Point: A paraspinal mass on postoperative spine MRI should be carefully searched for a hypointense contorted wire (the barium sulfate filament), as it may be the characteristic finding to evocate the diagnosis of gossypiboma.
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Gossypiboma is a rarely reported surgical complication and refers to a retained surgical textile in the body after a procedure. The surrounding inflammation and reaction often manifest as acute pain and subsequently require additional surgery. We report the case of a 33-year-old female who presented with acute abdominal pain one month after undergoing an exploratory laparotomy secondary to a gunshot wound in her home country. A diagnosis of retained foreign body was made with radiological imaging and confirmed upon the retrieval of two surgical sponges after the operation. Due to the high morbidity and mortality as well as increased healthcare costs, strict protocols must be followed to avoid such outcomes.
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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.