A serious medicolegal problem after surgery: gossypiboma

Abdominal pain secondary to gossypiboma that developed over 22 years: Case report

INTRODUCTION

Surgical instrument retention continues to occur despite considerable preventive efforts. The resulting infection can be asymptomatic or demonstrate variable clinical presentations, such as intestinal obstruction, malnutrition, gastrointestinal bleeding, peritonitis, adhesions, fistulas, abscesses, erosion and/or intestinal perforation. In this case report, we present a patient whose last surgical event occurred 22 years prior with appendicular symptoms and a palpable abdominal mass.

PATIENT PRESENTATION

The patient was a 42-year-old female with a history of three caesarean sections, the last one occurring 22 years prior. Her condition began with abdominal pain predominantly in the right iliac fossa, with a pain severity scale of 8/10, a palpable mass in the upper quadrants and mesogastrium of approximately 20 cmx10 cm. Clinical studies suggested a tumour in the epigastrium and mesogastrium; a subsequent exploratory laparotomy revealed a tumour with firm adhesions in the caecal appendix and omentum, a textiloma and a caecal appendix. The patient's condition evolved satisfactorily.

CLINICAL DISCUSSION

The textiles that are normally used for surgery are fibrous, with absorbent materials composed of sterilized cotton or synthetic fabrics. The most common sites of gossypiboma are the abdomen (56 %), pelvis (18 %) and thorax (11 %). The common clinical symptoms (50 %) are vague, occur in the gastrointestinal region, and include mild abdominal pain, nausea, and vomiting. The formation of adhesions, abscesses and fistulas has been reported in up to 31, 24 and 20 % of patients, respectively.

CONCLUSION

Gossypiboma is an unwanted but preventable surgical complication that is associated with increased morbidity and mortality from abdominal surgeries.

A case of intra-abdominal textiloma mimicking a mesenteric tumor

INTRODUCTION

A textiloma or gossypiboma is a retained surgical material in the body after an operation. It may be asymptomatic or revealed by complications such as occlusion, perforation, and fistulization.

CASE REPORT

We report a case of intraabdominal textiloma mimicking a mesenteric tumor. The patient has a history of open cholecystectomy. She was referred to our department for the discovery on abdominal computed tomography scan (CT-scan) of a mass in the mesentery. A laparotomy was performed observing a textiloma which was resected with part of the small intestine. The evolution was satisfactory for the patient.

DISCUSSION

Intraabdominal textiloma is the most frequently observed foreign body left after a surgical procedure. They can be asymptomatic or discovered incidentally for another cause. We describe two types of immune responses, tansudative and exudative response, depending on the antigenicity of the foreign body. Surgical resection is the gold standard of treatment.

CONCLUSION

Although they are rare, these foreign bodies can present real complications after an open surgery.

Few incidentally found interesting foreign objects in human body: a case series

Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.

Unusual journey of migratory foreign bodies in the alimentary tract

Foreign bodies are uncommon, and the migration of ingested or inserted foreign bodies within or out of the gastrointestinal tract is even rarer. Migration of foreign objects from the digestive system to the soft tissue in the neck, genitourinary tract, or abdominal cavity to intraluminal extension in bowel loops is an uncommon but well-reported occurrence. The accidentally retained surgical sponge (gossypiboma) following abdominal or pelvic surgery with transmural migration within the bowel is an extremely rare clinical presentation. The bowel can be penetrated by retained material, which moves within the bowel lumen, resulting in malabsorption, intestinal obstruction, either partial or complete. In a few cases, spontaneous expulsion occurs. The interpretation is done on radiographs in frontal and lateral projections X-rays, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (USG). Computed tomography (CT) is helpful if a radiopaque foreign body is suspected and is the modality of choice. We share with you 2 instances of foreign items migrating outside the digestive tract with a possible history of ingestion and a case of transmural migration of the postcesarean section retained surgical sponge within the alimentary tract, causing bowel obstruction. Diagnosis and the exact location of a foreign body can be established with the judicious use of different modalities. A CT scan is the modality of choice because it provides a road map for surgical intervention.

A 34-year-old asymptomatic gossypiboma: A fortuitous diagnosis revealed by appendicular peritonitis: A case report

Gossypiboma is a retained surgical sponge. Patients are usually symptomatic leading to early removal of this entity. We are reporting a 33-year-old asymptomatic gossypiboma discovered by appendicular peritonitis on the radiological images. The 64-year-old patient underwent a laparotomy with excision of the gossypiboma. The postoperative period was uneventful.

Transmural Migration of Gossypiboma with Intraluminal Small-Bowel Obstruction: A Case Report

Patient: Female, 26-year-old

Final Diagnosis: Gossypiboma

Symptoms: Abdominal pain

Medication:—

Clinical Procedure: —

Specialty: Surgery

Foreign Bodies in the Abdominal Area: Review of the Literature

The aim of this paper is to update and summarize the relevant literature on the anatomical localization, incidence, and diagnostic and therapeutic approaches to abdominal foreign bodies. A comprehensive review was carried out on recorded cases related to the presence of foreign bodies in the abdominal area throughout the literature. Moreover, the phenomenon was discussed in relation to different patient categories associated with childhood, mental or neurological illness, incarceration, and drug trafficking as well as sexual accident or abuse. Particular importance is ascribed to the underlying psychopathology and motivation of foreign body ingestion in each category of patients. The surgical, psychiatric and legal implications of the issue are discussed in detail.

Forensic - Pathological SEM/EDX analysis in prosecution of medical malpractice

The retention of gauze within the mediastinum is considered an exceptional finding. We are presenting the case of a woman, affected by aorto-mitral valvulopathy, in whose mediastinum was found, during the autopsy, a gauzome without signs of active phlogosis, which had been "forgotten" in a previous surgery, acted 14 years before the death. A 39 y.o. woman had received surgical treatment of double aorto-mitral valve substitution and tricuspid plastic. At age 53, she successfully received surgery once again at a different hospital; she then started rehabilitation therapy, during which she deceased due to sudden hematemesis with infectious multi organ failure. During the autopsy, a 5 cm long surgical gauze was found in the mediastinum. A SEM/EDX (Scanning Electron Microscopy with Energy Dispersive X-ray spectroscopy) exam was ran on the foreign body and a sample of the same gauze used in the cardiac-surgical department of the hospital the victim had passed away in, to act a comparison between the two kinds of material. The exam showed a morphological difference between exogenous fibers incorporated within the gauzome and the control gauze. This case highlights the diagnostic and interpretative challenges in finding a foreign body within the mediastinum without signs of active phlogosis. SEM/EDX investigations executed on the gauzome and a "control gauze" allowed the attribution of malpractice to the first hospital the victim had been operated in 14 years before the exitus. The SEM/EDX exam confirms its importance in correctly identifying the case, which becomes an example for similar happenings.

Foreign Body Granuloma After Cranial Surgery: A Systematic Review of Reported Cases

BACKGROUND

In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications.

METHODS

We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues.

RESULTS

There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data.

CONCLUSIONS

Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room.

Breast Textiloma: An unending medico-legal issue about a case report

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Forgetting sponges in the breast after surgery is uncommon and may mimic a recurrent tumor after years.

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Medico-legal implications are heavy which jeopardize the reputation of the surgeon.

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The patient was not informed about the real diagnosis because of fear of litigation.

Introduction

Textiloma is a mass composed of retained surgical textile foreign body. It is a rare iatrogenic complication that can engage the doctor’s responsibility. The aim of this manuscript is to report an unusual case of breast Textiloma mimicking a recurrent tumor and to highlight its medico-legal implications.

Presentation of case

A 47-year-old lady, without past medical history, was diagnosed with a breast infiltring intraductal carcinoma. She was treated with mastectomy. Four years later, the patient consulted her surgeon for a subcutaneous mass in the operative site. Both medical and radiological investigations concluded to recurrent tumor. Histological examination confirmed the diagnosis of Textiloma.

Discussion

Retained foreign bodies in the operative site are infrequent but serious iatrogenic complications. Clinical manifestations of Textiloma are variable and non-specific. It should be suspected in any postoperative case with unresolved or unusual problems. It can mimic other conditions such as tumor. Textiloma is a frequently injurious situation that can lead to medico-legal implications. It is considered to be a sample of medical negligence that involves the surgeon responsibility.

Conclusion

Textiloma is a preventable condition and it can be avoidable by maintaining standard recommendations.

Lower abdominal gossypiboma mimics ovarian teratoma: a case report and review of the literature

Background

Gossypiboma is a serious and potentially dangerous medico-legal problem.

Case presentation

We present a case of lower abdominal gossypiboma that presented as an abdominal cystic mass mimicking ovarian teratoma. The mass and the adhesive intestine loop were en blocly resected. The cut section confirmed gossypiboma diagnosis.

Conclusions

The present experience and related literature results indicate that gossypiboma should always be kept in mind for the differential diagnosis of cystic soft-tissue mass detected in patients with a prior operation history despite its rarity and diagnosis difficulty. Once detected or suspected, appropriate surgical intervention should be performed promptly. Most importantly, preventing is much more crucial than curing in order to avoid this highly undesired potential complication.

Gossypibomas, a surgeon's nightmare-patient demographics, risk factors, imaging and how we can prevent it

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.

Medicolegal consequences of thoracic gossypiboma: A case report

The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but it is associated with severe medical and legal consequences. The diagnosis can be missed despite radiological investigations. We report a case of a 15-year-old female who presented with fever, cough, dyspnea and hemoptysis. She had a history of hydatid cyst operation 2 years ago. Post-discharge follow up occurred for two years on hospital where hydatid cyst surgery had been done. Radiological investigations were inconclusive in detecting the retained sponge despite radiopaque marker. So gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as persistent respiratory symptoms after the operation.

[Gossypiboma after abdominal surgery is a challenging clinical problem and a serious medicolegal issue]

INTRODUCTION

The term "gossypiboma" refers to a textile matrix surrounded by foreign body reaction. Gauze and surgical dressings are the most commonly retained materials after laparotomy.

AIM

To evaluate the incidence of abdominal gossypiboma, its causes and the preventive measures to reduce the frequence and morbimortality.

METHOD

Was conducted a literature review in Medline/Pubmed in english. The survey was about the last 10 years, selecting the headings: gossypiboma, textiloma, retained foreign body and abdominal surgery. Thirty articles were considered in this review.

RESULTS

The incidence of gossypiboma is underreported, mostly due to the legal implications of their detection but also because many patients remain asymptomatic. Occur in 1/1000 to 1/1500 of intra-abdominal operations. Clinical presentation is variable, and depends on the location of the foreign body and on the type of inflammatory reaction presented by the host. The recommended course of treatment is excision, which can be accomplished endoscopically, laparoscopically, or via the open route, and seeks to prevent the complications that lead to a high mortality rate. The most important approach is prevention. Preventive measures required include exploration of the abdominal cavity at the end of the procedure, use of textiles with radiopaque markers and a meticulous account of surgical materials.

CONCLUSION

Gossypiboma is a former medical-legal problem, whose incidence is apparently increasing. Therefore needs to be revised to take preventive measures in the operating room.

Mediastinal gossypiboma simulating a malignant tumour

Gossypiboma or textiloma are two terms used to describe any cotton matrix such as gauze pads left behind during an operation in the body cavities. They may lead to infections or abscess formations, or may mimic malignant tumours. Here, we present a woman with a history of a previous operation on her thorax who became symptomatic 25 years after the operation because of retained surgical gauzes covered by fibrinous materials with adhesions to the left lung. The cotton matrix had developed into a gossypiboma mimicking a mediastinal tumour.