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Hatgaonkar A, Hatgaonkar K, Bankar NJ. Unusual journey of migratory foreign bodies in the alimentary tract. Radiol Case Rep 2023; 18:4042-4047. [PMID: 37680658 PMCID: PMC10480644 DOI: 10.1016/j.radcr.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
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.
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Affiliation(s)
- Anand Hatgaonkar
- Professor and Head, Department of Radiology, Datta Meghe Medical College Nagpur, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, India
| | - Kajal Hatgaonkar
- Assistant Professor, Department of Pathology, Datta Meghe Medical College Nagpur, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, India
| | - Nandkishor J. Bankar
- Associate Professor, Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi (Meghe), Wardha, India
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Bai YF, Niu JQ, Zhang C, Wang W, Liu JZ. Computed Tomography and Magnetic Resonance Imaging Appearances of Abdomen and Pelvis Gossypibomas at the Varied Durations After Cesarean Section. Cureus 2021; 13:e18588. [PMID: 34765355 PMCID: PMC8575338 DOI: 10.7759/cureus.18588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/15/2022] Open
Abstract
The incidence of gossypiboma is considerably higher in open cavity surgeries, among which cesarean section ranks number one. However, it is difficult to diagnose abdomen or pelvic gossypibomas after cesarean section. We retrospectively analyzed the clinical and imaging data of three pathologically confirmed gossypiboma patients at varied durations after cesarean section. In case one, at four months after cesarean section, a gossypiboma near the small intestine caused fistula and intestinal obstruction. Soft tissue density lesion along the intestinal canal made the “segmental honeycomb sign" and "truncation" with metal markings on the edge on computed tomography (CT). Magnetic sensitivity artifacts were demonstrated as hypointensity on T1 weighted image (T1WI) and T2 weighted image (T2WI), while hyperintensity was seen on the diffusion weighted image (DWI). In case two, a gossypiboma in the peritoneal and intestinal space was revealed with MRI at 18 months after cesarean section. It was featured as a cystic and solid lesion, with "vortex like sign" and obvious ring enhancement on contrast-enhanced MRI scan. In case three, five years after cesarean section, a mass was palpated in the right middle and lower abdomen. MRI revealed a round mass of T1 hypointensity with mixed T2 signal, as well as swirling hypointensity in T2WI, T2WI-fat suppression (FS), and DWI. In CT and MRI examinations for suspected gossypiboma after cesarean section, "honeycomb sign" and "vortex like sign" are the characteristic appearances; gauze translocated into the intestine may show the "truncation sign". Accurate diagnosis is based on the surgery history, symptoms, and imaging features.
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Affiliation(s)
- Yu-Feng Bai
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Juan-Qin Niu
- Department of Radiology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, CHN
| | - Chao Zhang
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Wen Wang
- Department of Radiology, Fourth Military Medical University, Shaanxi, CHN
| | - Jing-Zhong Liu
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
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Kanat BH, Kutluer N, Bozan MB, Aksoy N, Öztürk T. A FORGOTTEN STATUS: GOSSYPIBOMA. ACTA ACUST UNITED AC 2021; 34:e1571. [PMID: 34008712 PMCID: PMC8121046 DOI: 10.1590/0102-672020190004e1571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/21/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Burhan Hakan Kanat
- University of Health Sciences, Elazığ City Hospital, Department of General Surgery, Elazig/Turkey
| | - Nizamettin Kutluer
- University of Health Sciences, Elazığ City Hospital, Department of General Surgery, Elazig/Turkey
| | - Mehmet Buğra Bozan
- Medical Faculty of Kahramanmaras Sutcu Imam University, Department of General Surgery, Kahramanmaras/Turkey
| | - Nurullah Aksoy
- Siverek State Hospital, Department of General Surgery, Şanlıurfa/Turkey
| | - Tülin Öztürk
- University of Health Sciences, Elazığ City Hospital, Department of Radiology, Elazig/Turkey
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Kabba MS, Forde MY, Beckley KS, Johnny B, Jah-Kabba AMBM, Seisay SB, Dawoh AM, Ogundiran T. Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report. BMC Surg 2020; 20:242. [PMID: 33069217 PMCID: PMC7568021 DOI: 10.1186/s12893-020-00904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. Case presentation A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. Conclusion This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.
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Affiliation(s)
- Mustapha S Kabba
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone.
| | - Martha Y Forde
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Kevin S Beckley
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Bernadette Johnny
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Ann-Marie B M Jah-Kabba
- Department of Radiology, Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Samuel B Seisay
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Alusine M Dawoh
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Temidayo Ogundiran
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone and Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone.,College of Medicine, University of Ibadan & University College Hospital, Ibadan, Nigeria
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de Sousa JB, Alves Martins BA, Rocha Ferreira IA, E Silva SM, de Oliveira PG. Transmural Migration of Gossypiboma with Intraluminal Small-Bowel Obstruction: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924506. [PMID: 32817594 PMCID: PMC7458695 DOI: 10.12659/ajcr.924506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 26-year-old Final Diagnosis: Gossypiboma Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
| | | | | | - Silvana Marques E Silva
- Unit of Coloproctology, Federal District Strategic Health Management Institute (Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF)), Brasília, Brazil
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Gómez-Jurado MJ, Curell A, Martín R, García Ruiz de Gordejuela A, Armengol M. Lower gastrointestinal bleeding due to colonic fistula caused by a gossypiboma: Case report and literature review. Int J Surg Case Rep 2020; 72:59-62. [PMID: 32506032 PMCID: PMC7283079 DOI: 10.1016/j.ijscr.2020.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Even in modern surgery, human mistakes cannot be totally avoided. Retained surgical items are among the most feared ones. Forgotten sponges inside patients can cause a wide range of complications due to the foreign body reaction, called gossypiboma. The incidence of gossypibomas in the literature is probably underreported due to its legal implications; however, we must know its consequences and highlight the importance of the prevention strategies. We present a case where only preventive measures would have avoided its fatal outcome. PRESENTATION OF CASE An 85-year-old male, previous left nephrectomy 12 years before, came to the emergency room with hematochezia and hemodynamic instability. An emergent angio-CT revealed a 12 cm mass due to a gossypiboma near the descending colon; the presence of air suggested an infection and/or fistulization to the bowel. It was decided not to perform invasive procedures, resulting in the patient's death. DISCUSSION Gossypibomas can remain asymptomatic for years, being diagnosed when causing an obstruction, malabsorption, septic symptoms or even spontaneously. This may lead to high morbidity and mortality rates. In order to prevent it, different strategies have been described, with the objective to intensify surveillance. When diagnosed, laparotomy, laparoscopic and even endoscopic procedures have been performed successfully. CONCLUSION We suggest putting all our efforts in identifying high risk patients and surgeries, training the OR team and enhancing protocols and checklists to minimize any preventable errors.
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Affiliation(s)
- María José Gómez-Jurado
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Anna Curell
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Rocío Martín
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Amador García Ruiz de Gordejuela
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Spain.
| | - Manel Armengol
- Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Spain
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Oliveira R, Matsui A, Ribeiro J, Simionato G, Simamura A, Canola J, Camplesi A, Vasconcelos R, Moraes PC. Clinical and pathological aspects of gossypiboma in a dog: case report. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT A female dog was treated at the Veterinary Hospital Governador Laudo Natel for symptomscaused by an intra-abdominal gossypiboma (gossypium: cotton; boma: place of hiding). Showing high morbidity and mortality, the gossypiboma is a granulomatous reaction that is formed in response to exposure to a textile matrix. The objective of this report is to describe the clinical and pathological findings of an intra-abdominal gossypiboma in a female dog. This patient arrived at urgent care showing increased abdominal volume, pain, and cachexia. Ultrasonography showed a regular contour formation that could not be completely delimited. The patient underwent exploratory laparotomy and died in the postoperative period. The gossypiboma had a smooth, firm, and purple-gray exterior surface. Microscopy revealed a severe reaction of desmoplasia around the necrotic region, residual textile material, and adipose tissue. Negligence by veterinarians leading to this condition can result in patients’ death as well as causing psychological damage to owners.
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Affiliation(s)
- R. Oliveira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - A. Matsui
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | | | - G. Simionato
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - A.C. Simamura
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - J. Canola
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - A. Camplesi
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - R.O. Vasconcelos
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | - P. C. Moraes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
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Tanrıkulu Y, Tanrıkulu CŞ, Yılmaz G, Bıçakcı E. Idiopathic weight loss due to an entero-enteric fistula from a gossypiboma retained for 27 years. Turk J Surg 2018; 34:65-67. [PMID: 29756112 DOI: 10.5152/turkjsurg.2017.3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
Gossypiboma refers to a mass formed around surgical instruments or materials left in the body postoperatively. The occurrence of gossypibomas remains an important problem, despite improvements in surgical procedures and operating room facilities. The clinical presentation of gossypiboma can vary depending on the host response. This report describes a case of abdominal gossypiboma after splenectomy. A 48-year-old man who had undergone splenectomy 27 years ago was admitted to our clinic suffering from non-specific symptoms for 2 weeks. He was cachectic, but laboratory test results were normal. Abdominal ultrasonography and computed tomography revealed a mass in the left hypochondrium. An entero-enteric fistula and an encapsulated foreign body (surgical compress) were detected during an exploratory laparotomy, and the foreign body was removed. Preventing gossypibomas is very important because of their potential to create medico-legal problems and increase mortality and morbidity. Therefore, forgotten surgical material should be considered in all patients with a surgical history, and surgery should be performed carefully.
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Affiliation(s)
- Yusuf Tanrıkulu
- Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Ceren Şen Tanrıkulu
- Department of Emergency Medicine, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Gökhan Yılmaz
- Department of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Ercan Bıçakcı
- Department of Gastroenterology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
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Gualniera P, Scurria S. Retained surgical sponge: Medicolegal aspects. Leg Med (Tokyo) 2018; 31:78-81. [DOI: 10.1016/j.legalmed.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/27/2016] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
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Zhang H, Jiang Y, Wang Q, Liu J. Lower abdominal gossypiboma mimics ovarian teratoma: a case report and review of the literature. World J Surg Oncol 2017; 15:6. [PMID: 28061867 PMCID: PMC5217399 DOI: 10.1186/s12957-016-1082-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Hao Zhang
- Department of General Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, 314001, China.
| | - Yanyong Jiang
- Department of General Surgery, Puding County People's Hospital, Anshun, Guizhou, 562100, China
| | - Qingqing Wang
- Department of General Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, 314001, China
| | - Jun Liu
- Department of General Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, 314001, China
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Rabie ME, Hosni MH, Al Safty A, Al Jarallah M, Ghaleb FH. Gossypiboma revisited: A never ending issue. Int J Surg Case Rep 2015; 19:87-91. [PMID: 26741272 PMCID: PMC4756180 DOI: 10.1016/j.ijscr.2015.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
Abstract
Retained foreign objects (RFO), is one of the most dreadful complications of surgery. Despite a seemingly correct count, laparotomy pads were missed at the end of surgery in three patients. Human errors continue to occur and RFO continues to plague the surgical practice. To avoid human error, one of several recent technologies designed to check for items left behind, should be employed. In our report, we give an important tip on how to extract the retained surgical sponge without causing much damage.
Introduction Leaving a surgical item inside the patient at the end of surgery, is one of the most dreadful complications. The item is frequently a surgical sponge and the resultant morbidity is usually severe. Additionally, the event poses considerable psychic strain to the operating team, notably the surgeon. Presentation of cases Here we describe the clinical course of three patients in whom a surgical sponge was missed, despite a seemingly correct count at the end of difficult caesarean sections. In two patients, who presented shortly after surgery, the pad was extracted with no bowel resection. In the third patient, who presented several years after surgery, colectomy was performed. Discussion Gossypiboma is under reported and the true incidence is largely unknown. Depending on the body reaction and the characters of the retained sponge, the patient may present within months to years after surgery. Risk factors for retained foreign objects include emergency surgery, an unplanned change in the surgical procedure, higher body mass index, multiple surgical teams, greater number of major procedures done at the same time and incorrect count recording. The surgical procedure needed to extract the retained sponge may be a simple one, as in the first case, or it may be more complex, as seen in the other two cases. Although holding the correct count at the end of surgery is the gold standard safeguard against this mishap, human errors continue to occur, as happened in our patients. For that reason, the correct count should be supplemented by employing one of the several new technologies currently available. Conclusion Gossypiboma continues to occur, despite precautionary measures. As its consequences might cost the patient his life and the surgeon his professional reputation, extra preventive measures should be sought and implemented. New advances in technology should be incorporated in the theatre protocol as additional safeguard against human error. When encountered, a direct incision over the encapsulated swelling, in contrast to a formal laparotomy incision, might simplify the surgical procedure.
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Affiliation(s)
- M Ezzedien Rabie
- Department of Surgery, Aseer Central Hospital-Abha, Saudi Arabia.
| | | | - Alaa Al Safty
- Department of Surgery, Aseer Central Hospital-Abha, Saudi Arabia
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