Retained surgical sponge: an unusual cause of intestinal obstruction

Endoscopic removal of a transgastric migrated textiloma: a case report

Aim: Abdominal textiloma is an uncommon postoperative complication which can result in a fistula with luminal migration in the digestive tract. Surgery has been the mainstay method for textiloma removal; however, removal of retained gauze by upper gastrointestinal endoscopy is possible avoiding reoperation. Case report: We report a case of an abdominal textiloma in a 38-year-old male, which migrated into the stomach and was extracted by upper endoscopy. Conclusion: Endoscopic extraction after a luminal migration of the abdominal textiloma in the digestive tract facilitate its management and could avoid surgery.

Transmural migration of a surgical compress into the stomach after splenectomy: a case report

A surgical compress retained in the abdominal cavity following surgery is a serious problem. Here, we describe a 33-year-old female who was admitted with abdominal pain, vomiting, no passage of gas or feces, and abdominal distension for 3 days. She had a splenectomy at another medical center 4 years previously. An upright plain abdominal film revealed small bowel obstruction with marked small bowel air-fluid levels. The physical examination revealed muscular guarding and rebound tenderness in the periumbilical region. Therefore, a laparotomy was performed. A surgical compress was removed at enterotomy and the final diagnosis was gossypiboma. Because a retained surgical compress may lead to medicolegal problems, it is important to count the material used before and after a surgical procedure to reduce the risk of this problem.

Trans-visceral migration of retained surgical gauze as a cause of intestinal obstruction: a case report

INTRODUCTION

A retained surgical sponge in the abdomen is uncommon although it is likely that this finding is underreported in the medical literature. The intravisceral migration of retained surgical gauze is even rarer, as demonstrated by the very few cases reported.

CASE PRESENTATION

Three years after undergoing anterior resection of the rectum, a 75-year-old man presented with symptoms of small bowel obstruction. Plain abdominal radiography and CT showed a radio-opaque marker; a foreign body was suspected, probably a piece of retained surgical gauze. An ileotomy of about 5 cm. was performed to confirm this diagnosis and remove the gauze.

CONCLUSION

Although rare, retained gauze in the abdomen is a complication of surgery. The authors consider that this event may be more frequent than it appears from reports in the literature, probably because of its medico-legal implications. If all such cases were reported, it would be possible to estimate their exact number, classify the occurrence as a possible surgical complication and thus modify its medico-forensic consequences.

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.

[Retained foreign bodies from the surgical point of view]

The number of foreign bodies remaining in the patient after a surgical procedure is presumably higher than mentioned in the literature. According to US insurance statistics, the incidence amounts to 1 in 1,500 surgical procedures. As a basic principle--also from the legal aspect--it is necessary to determine whether a foreign body was left in situ accidentally (i.e. due to a material fault) or if it was simply forgotten. In 70% of cases, fabric items (e.g. swabs etc.) are left behind, while around 30% are metal objects. A particularly high risk is seen in emergency settings, in unexpected changes in the surgical procedure, or for patients with a high body mass index. The outcome for the patient differs depending on the nature of the object left behind and the individual patient's situation. Usually, metal items cause more acute clinical symptoms at an earlier time after the operation. Fabric items tend to induce, in the absence of primary contamination, a chronic progression of symptoms over several years. Reoperation has a high mortality (between 11% and 35%). Precautions in terms of risk management have to be established and need to be strictly respected, especially in high risk settings. Visually or acoustically controlled monitoring before wound-closure are recommended to eliminate "human error" as thoroughly as possible.

An Evaluation of a Numbered Surgical Sponge Product

Surgical sponge counting is an essential patient safety measure in the OR in which all members of the surgical team must participate. The RN acting as circulator is responsible for accurately documenting sponge counts during the surgical procedure. A sequentially numbered sponge product was evaluated in a survey of OR personnel to determine ease of use and whether the product affected the flow of the surgical procedure. Survey respondents reported that the numbered sponge product was easy to use and did not lengthen or affect the flow of the surgical procedure. Respondents also indicated that the product may contribute to patient safety.

Gossipiboma intra-abdominal: análise de 15 casos

OBJETIVO: O objetivo do presente trabalho é avaliar retrospectivamente as características e o resultado do tratamento de 15 casos de corpo estranho de natureza têxtil retido na cavidade abdominal após diferentes tipos de operações. MÉTODO: Analisamos retrospectivamente os dados demográficos de 15 pacientes com diagnóstico de gossipiboma tratados no Hospital Universitário Gaffrée-Guinle no período de janeiro de 1987 a janeiro de 2007. RESULTADOS: Onze pacientes (73%) eram mulheres e quatro eram homens (27%), com mediana da idade de 50 anos. As operações prévias foram de natureza ginecológica (40%), gastrointestinal (27%), urológica (13%), obstétrica (13%) e oncológica (7%). Dois deles haviam sido submetidos a tratamento cirúrgico de urgência. O intervalo de tempo entre a operação primária e o diagnóstico definitivo variou de uma semana a 50 meses, com mediana de oito meses. A queixa preponderante foi dor associada ou não a tumoração abdominal e obstrução intestinal. O problema foi confirmado pela tomografia computadorizada em 12 oportunidades. Todos os pacientes tiveram o corpo estranho removido. As taxas de morbidade e mortalidade pós-operatórias foram respectivamente 26,6% e 0%. CONCLUSÕES: Houve predomínio de mulheres e o tipo de operação que mais contribuiu foi a de natureza ginecológica. A hipótese de gossipiboma deve ser aventada sempre que há operação prévia e queixas incompatíveis com a evolução usual. A tomografia computadorizada foi importante para corroborar o diagnóstico. A identificação de fatores de risco para retenção de corpo estranho só foi possível num pequeno número de casos de nossa amostragem. Apesar da elevada taxa de morbidade pós-operatória, a evolução foi satisfatória e sem mortalidade. A prevenção somente será efetiva se adotadas regras rígidas de controle com observância rigorosa das mesmas, aliadas ao treinamento apropriado de toda a equipe cirúrgica.

Spontaneous transmural migration of surgical sponges

Postoperative retained surgical sponges or other foreign bodies are usually underreported. Radio-opaque materials are usually detected on follow-up radiological investigations, but radiolucent materials such as sponges create diagnostic problems and clinically mimic various abdominal pathologies. Introduction of spiral computed tomography, magnetic resonance imaging and dedicated ultrasonography has enabled clinicians to find these foreign bodies at the earliest opportunity to avoid disastrous complications. Spontaneous transmural migration and expulsion per rectum of more than one sponge without sequelae is also possible. We report one such interesting case.

Retained surgical sponges (gossypiboma)

OBJECTIVE

Retained surgical sponges are seldom reported due to medicolegal implications. Awareness of this problem among surgeons and radiologists is essential to avoid unnecessary morbidity. We present our experience with this entity and review the related literature.

METHODS

The medical records of 11 patients who were diagnosed as having retained surgical sponges from 1990 to 2003 were reviewed.

RESULTS

The incidence was 1:5,027 inpatient operations. There were four males and seven females with a median age of 45 years. The original operations were gynaecological (n=4), general (n=4), urological (n=2) and laminectomy (n=1). In seven cases, the original operation was performed on an emergency basis. Five patients were obese. A presumed correct sponge count was documented in eight cases. The median time between the original procedure and diagnosis of retained sponges was 12 months. The tentative diagnosis was intestinal obstruction (4 patients), urinary tract infection (1 patient), Crohn's disease (1 patient) and tumour recurrence (1 patient). The correct diagnosis was suggested in the remaining four patients. Surgical removal of the retained sponges was carried out in all cases except one, in which the patient passed the sponge spontaneously through the rectum.

CONCLUSION

Retained sponges are more common in obese patients and after emergency surgery. A high degree of suspicion is important for preoperative diagnosis. Despite the use of radio-opaque sponges and thorough sponge counting, this moribund mishap still occurs. Although human errors cannot be completely abolished, continuous medical training and strict adherence to regulations should reduce the incidence to a minimum.

Imaging of Transmural Migration of A Retained Surgical Sponge: A Case Report

A 61-year-old woman who had undergone a hysterectomy 15 years before this presentation had suffered from intermittent abdominal pain and a palpable lower abdominal mass for 3 months. Plain roentgenography revealed a radiopaque mass with serpiginous density in the pelvic region. Sonography showed curvilinear hyperechogenicity with an acoustic shadow. A small-bowel series revealed a huge amorphous filling defect inside the ileum. Computed tomography showed that the mass was a spongiform object with a whirl-like appearance mixed with air and with peripheral calcification.