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Shyam K, Bhari Thippeswamy P, Shetty AP, Algeri R, Rajasekaran S. Gauze for concern: A Case Report and systematic review of delayed presentation of paraspinal textiloma. J Clin Orthop Trauma 2022; 32:101967. [PMID: 36051862 PMCID: PMC9424584 DOI: 10.1016/j.jcot.2022.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022] Open
Abstract
Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as cotton or gauze pads that are accidentally retained in the surgical bed post-operatively. They may present acutely with signs of infection or may rarely remain chronic and asymptomatic; the latter posing a significant challenge to clinical and imaging diagnosis. Textilomas are not routinely reported due to their medicolegal implications and are usually encountered fortuitously. Here, we report a case of an individual who presented with a non-specific lower backache, had a remote history of lumbar discectomy and in whom a textiloma at the postoperative site was seen to mimic a soft-tissue mass on imaging. In addition, we review current, up-to-date literature on delayed presentations of such retained materials after surgery of the lumbar spine. Case report A 43-year-old male presented with pain in his right lower back and gluteal region. He had undergone an L4-L5 discectomy 11 years ago, remained asymptomatic since, and noticed an insidious, worsening pain a week before presentation. Mild tenderness was elicited over the region of pain. A clinical diagnosis of L4-L5 extraforaminal disc prolapse with deep surgical site infection was made. Ultrasound showed an iso-to-hyperechogenic lesion in the right lower paraspinal region. MRI showed a very well-defined, ovoid T1-hypointense and T2-iso-hypointense lesion in the deep posterior paraspinal region of the L4/5 level adjacent to right laminar process of L4 vertebra. The lesion caused scalloping and chronic erosion of the laminar process. No obvious air pockets were present. The features of infection, like soft tissue oedema and collection, were absent. Based on imaging, differentials of nerve sheath tumour and gossipybomas was made. Open wound exploration was performed, which showed a wad of gauze within the right L4-L5 interlaminar space, with thin surrounding granulation tissue. The L4-L5 disc and exiting nerve root were normal. The mass was removed, local washing was done and wound was closed. Conclusion Though unfortunate and relatively rare, the possibility of a textiloma must be considered among the differential diagnoses of a mass in the spinal region in the event of prior surgery, no matter how remote the history. Clinical presentation may vary, but the imaging appearance is largely consistent and can be relied upon to prevent unnecessary investigation and facilitate early surgical removal of the offending retained material.
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Ajoy Prasad Shetty
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Raksha Algeri
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Shanmuganathan Rajasekaran
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
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Weprin S, Crocerossa F, Meyer D, Maddra K, Valancy D, Osardu R, Kang HS, Moore RH, Carbonara U, J Kim F, Autorino R. Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf Surg 2021; 15:24. [PMID: 34253246 PMCID: PMC8276389 DOI: 10.1186/s13037-021-00297-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A retained surgical item (RSI) is defined as a never-event and can have drastic consequences on patient, provider, and hospital. However, despite increased efforts, RSI events remain the number one sentinel event each year. Hard foreign bodies (e.g. surgical sharps) have experienced a relative increase in total RSI events over the past decade. Despite this, there is a lack of literature directed towards this category of RSI event. Here we provide a systematic review that focuses on hard RSIs and their unique challenges, impact, and strategies for prevention and management. METHODS Multiple systematic reviews on hard RSI events were performed and reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Database searches were limited to the last 10 years and included surgical "sharps," a term encompassing needles, blades, instruments, wires, and fragments. Separate systematic review was performed for each subset of "sharps". Reviewers applied reciprocal synthesis and refutational synthesis to summarize the evidence and create a qualitative overview. RESULTS Increased vigilance and improved counting are not enough to eliminate hard RSI events. The accurate reporting of all RSI events and near miss events is a critical step in determining ways to prevent RSI events. The implementation of new technologies, such as barcode or RFID labelling, has been shown to improve patient safety, patient outcomes, and to reduce costs associated with retained soft items, while magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of metallic RSI recovery. CONCLUSION The entire healthcare system is negatively impacted by a RSI event. A proactive multimodal approach that focuses on improving team communication and institutional support system, standardizing reports and implementing new technologies is the most effective way to improve the management and prevention of RSI events.
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Affiliation(s)
- Samuel Weprin
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Dielle Meyer
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Kaitlyn Maddra
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - David Valancy
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Reginald Osardu
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Hae Sung Kang
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Robert H Moore
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Dept of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Fernando J Kim
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Center, Colorado, Denver, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA.
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Contegiacomo A, Conti M, Trombatore P, Dezio M, Muciaccia M, Lozupone E, Natale L, Manfredi R. Radiological features and management of retained needles. Br J Radiol 2020; 93:20200316. [PMID: 32516553 DOI: 10.1259/bjr.20200316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The identification of retained needles is essential because of their sharp structure with possible life-threatening complications. However, radiological evaluation could be challenging, especially in case of needles' relatively poor conspicuity and small dimension. This pictorial essay focuses on clinical issues (needle features, retention mechanisms and associated complications) and technical aspects (choice of the best diagnostic modality and technique) that can lead the radiologist to an earlier and proper diagnosis of needle retention in order to provide the best treatment for the patient.
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Affiliation(s)
| | - Marco Conti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Emilio Lozupone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Natale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
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Patial T, Thakur V, Vijhay Ganesun N, Sharma M. Gossypibomas in India - A systematic literature review. J Postgrad Med 2017; 63:36-41. [PMID: 28079043 PMCID: PMC5394815 DOI: 10.4103/0022-3859.198153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose of Review: Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature. Materials and Methods: A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India. Results: On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%). Conclusions: Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.
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Affiliation(s)
- T Patial
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - V Thakur
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - N Vijhay Ganesun
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - M Sharma
- Department of Forensic Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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