Hidden retained surgical sponge with intestinal migration: A rare case report

Gossypiboma-induced ileal obstruction following cholecystectomy: A case report and literature review

INTRODUCTION

Gossypiboma, the retention of surgical material in the body post-surgery, is a rare but serious complication often underreported due to legal and reputational concerns. It commonly occurs after abdominal surgeries, with presentations ranging from abscess formation to intestinal obstruction.

PRESENTATION OF CASE

An 18-year-old girl presented with abdominal pain and distention, along with vomiting for six weeks after cholecystectomy. Initial misdiagnoses as pancreatitis delayed appropriate treatment. Exploratory laparotomy revealed an intra-abdominal gossypiboma, which had transmigrated into the ileum, causing obstruction. Surgical removal of the retained pack and ileal resection with primary anastomosis were performed, leading to a successful recovery.

DISCUSSION

The incidence of gossypiboma varies widely and depends on surgical practices. Transmural migration into the gastrointestinal tract, as seen in this case, is rare and potentially life-threatening. Accurate sponge counts, use of radio-opaque materials, and adherence to safety protocols are crucial preventive measures. Imaging modalities aid diagnosis, but surgical exploration remains definitive in uncertain cases.

CONCLUSION

This case highlights the critical need for awareness, accurate surgical protocols, and vigilance in postoperative management to prevent and manage gossypibomas. Early recognition and intervention can mitigate complications and improve patient outcomes.

The Retained Surgical Items Risk Assessment Scale: Development and Psychometric Characteristics

INTRODUCTION

Retained surgical items in operating rooms (ORs) continue to contribute significantly to medical errors. The first step in addressing the problem of retained surgical items is to identify the main risk factors. Identification of risk factors can impact OR standards and reduce such errors.

METHODS

The research included 270 participants. The data of the study were collected with the Sociodemographic and Clinical Characteristics Form, Operating Room Count Control Form and the Retained Surgical Items Risk Assessment Scale developed. In the analysis of the data, Content Validity Index, Cronbach α, item-total score correlation, Kuder-Richardson, Kappa, exploratory and confirmatory factor analysis, and Receiver Operating Characteristic (ROC) curve analysis were performed.

RESULTS

The Content Validity Index of the scale was 0.92. Kappa value was 0.993. The explained variance in the exploratory factor analysis of the scale was 50.03%. After confirmatory factor analysis, two factors were obtained for the final version of the 15 items. Factors had been determined as "Count and Surgery" and "Equipment". Among the subdimensions of the scale, Cronbach's α values were between 0.742 and 0.760, and 0.722 for the entire scale. When the ROC analysis results were examined, the cut-off point was ≥8, the specificity was 93.13%, and the sensitivity was 87.50%. The area under the ROC curve was calculated as 0.938.

CONCLUSIONS

The scale was presented as a valid and reliable measurement tool developed to assess the Retained Surgical Items Risk in ORs. If high-risk patients are checked and necessary precautions are taken before leaving the ORs, the incidence of retained surgical items can be significantly reduced.

Gossypiboma as a rare complication of septoplasty procedure: case report and review of literatures

Background

Foreign body granuloma due to retained surgical sponge is also called gossypiboma. Only one case of nasal septum gossypiboma has been reported.

In this report, we present a case of retained surgical sponge at the septoplasty site.

Case presentation

A 16-year-old male patient came to our emergency department complaining of nasal obstruction associated with low-grade fever. With past history of septoplasty 3 months ago. Endoscopic examination of the nasal cavity revealed bilateral smooth swelling of the nasal septum, no fluid was detected with aspiration. A CT scan of the nose and paranasal sinuses revealed significant posterior septal swelling. A consent had been taken from the parents, and the patient was prepared for endoscopic exploration under general anesthesia. Elevation of bilateral mucoperichondrial and mucoperiosteal flaps was done. There was a firm swelling with intense reaction all around, after meticulous dissection of this lesion and was delivered with Blakesley forceps. On closer examination it was a missed cotton ball. The patient follow-up for 12 months was excellent with complete disappearance of his complaints.

Conclusions

Retained surgical items should be considered in the differential diagnosis of post-operative nasal septum swellings. Sponges used for nasal surgery should be of appropriate size and attached to a thread and should be counted.