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Endara SA, Dávalos GA, Zamora E E, Redrobán LM, Molina GA. 'Chest gossypiboma after spinal surgery, not so easy to forget'. J Surg Case Rep 2023; 2023:rjad328. [PMID: 37337532 PMCID: PMC10276976 DOI: 10.1093/jscr/rjad328] [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: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
During any surgical procedure, complications may arise, some of which are fortuitous, whereas others, unfortunately, occur because of errors of the surgical team. Fortunately, most are minor and do not affect the patient's recovery, but others can cause severe morbidity and even mortality. A retained cotton or gauze surgical sponge inadvertently left in the body during an operation is known as a gossypiboma. This dreadful oversight is a marked complication that can cause serious postoperative complications, a severe economic burden on the healthcare system, and many medicolegal implications. We report the case of a 30-year-old male, who suffered a spinal fracture which was repaired through an anterior fixation approach 12 years ago in a local state hospital without complications. Suddenly, he presented with chest pain and cough, and sought medical attention. An 8 × 5 × 8 cm low-density heterogeneous mass was discovered on his chest; after successful surgery, a gossypiboma formed by several gauzes without radiopaque markers was discovered.
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Affiliation(s)
- Santiago A Endara
- Correspondence address. Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesus Oe7/47 y Conclina, Edificio Diagnostico 2000 tercer piso 3/3, Quito 170129, Ecuador. Tel: +593 99 841 6157; E-mail:
| | - Gerardo A Dávalos
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Elizabeth Zamora E
- Department of Internal Medicine, Division of Radiology, Hospital Metropolitano, Quito, Ecuador
| | - Ligia M Redrobán
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
| | - Gabriel A Molina
- Department of Surgery, Hospital Metropolitano, Quito, Ecuador
- Universidad San Francisco de Quito (USFQ), Quito, Ecuador
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Susmallian S, Barnea R, Azaria B, Szyper-Kravitz M. Addressing the important error of missing surgical items in an operated patient. Isr J Health Policy Res 2022; 11:19. [PMID: 35382877 PMCID: PMC8981682 DOI: 10.1186/s13584-022-00530-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aim to analyze the characteristics of incidences of missing surgical items (MSIs) and to examine the changes in MSI events following the implementation of an MSI prevention program. Methods All surgical cases registered in our medical center from January 2014 to December 2019 were retrospectively analyzed. Results Among 559,910 operations, 154 MSI cases were reported. Mean patient age was 48.67 years (standard deviation, 20.88), and 56.6% were female. The rate of MSIs was 0.259/1000 cases. Seventy-seven MSI cases (53.10%) had no consequences, 47 (32.41%) had mild consequences, and 21 (14.48%) had severe consequences. These last 21 cases represented a rate of 0.037/1000 cases. MSI events were more frequent in cardiac surgery (1.82/1000 operations). Textile elements were the most commonly retained materials (28.97% of cases). In total, 15.86% of the cases were not properly reported. The risk factors associated with MSIs included body mass index (BMI) above 35 kg/m2 and prolonged operative time. After the implementation of the institutional prevention system in January 2017, there was a gradual decrease in the occurrence of severe events despite an increase in the number of MSIs. Conclusion Despite the increase in the rate of MSIs, an implemented transparency and reporting system helped reduce the cases with serious consequences. To further prevent the occurrence of losing surgical elements in a surgery, we recommend educating OR staff members about responsibility and obligation to report all incidents that are caused during an operation, to develop an event reporting system as well as "rituals" within the OR setting to increase the team's awareness to MSIs. Trial registration Clinicaltrials.gov (NCT04293536). Date of registration: 08.01.2021. https://clinicaltrials.gov/ct2/show/NCT04293536.
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Affiliation(s)
- Sergio Susmallian
- Department of Surgery, Assuta Medical Center, 20 Habarzel Street, 69710, Tel Aviv, Israel. .,Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel.,School of Health Systems Management at Netanya Academic College, Netanya, Israel
| | - Bella Azaria
- Medicine Division, Assuta Medical Center, Tel Aviv, Israel
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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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Sayan B, Yamansavci Sirzai E, Yildizeli B. A Word of Caution for Gossypiboma. Thorac Cardiovasc Surg 2021; 70:579-582. [PMID: 34376001 DOI: 10.1055/s-0041-1731779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Gossypiboma, a retained nonabsorbable surgical sponge, is a major safety issue despite being infrequent, causing serious malpractice debates. In addition to this, it may mimic a range different disease within the thorax and even have unpleasant clinical presentations even after years.In this article, we report four gossypiboma cases with nonspecific clinical presentations to emphasize the importance of keeping this diagnosis in mind with all patients who have had a previous operation.
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Affiliation(s)
- Bihter Sayan
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Bedrettin Yildizeli
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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Gavrić Lovrec V, Cokan A, Lukman L, Arko D, Takač I. Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review. J Int Med Res 2018; 46:4775-4780. [PMID: 30222013 PMCID: PMC6259383 DOI: 10.1177/0300060518788247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although the incidence of retained surgical items (RSIs) is low, it is nevertheless an important preventable cause of patient injury that can ultimately lead to the patient's death and to subsequent high medical and legal costs. Unintentional RSI is the cause of 70% of re-interventions, with a morbidity of 80% and mortality of 35%. The most common RSIs are sponges or gauze (gossypiboma or textiloma), while retained surgical instruments and needles are rare. Perioperative counting of equipment and materials is the most common method of screening for RSIs, while a diagnosis can later be confirmed by the clinical appearance and by imaging studies. We present a rare case of a 43-year-old patient who was admitted to our hospital because of two retained needles following a cesarean section, despite several subsequent laparotomies. One needle had been removed previously, but in addition to the remaining needle, we also removed a retained gauze. The diagnosis of RSIs is extremely important, and safe surgical practices including the addition of new imaging technologies should be encouraged to detect RSIs.
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Affiliation(s)
- Vida Gavrić Lovrec
- Division of Gynecology and Perinatology, University of Maribor Clinical Center, Maribor, Slovenia
| | - Andrej Cokan
- Division of Gynecology and Perinatology, University of Maribor Clinical Center, Maribor, Slovenia
- Andrej Cokan, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Lara Lukman
- Division of Gynecology and Perinatology, University of Maribor Clinical Center, Maribor, Slovenia
| | - Darja Arko
- Division of Gynecology and Perinatology, University of Maribor Clinical Center, Maribor, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Iztok Takač
- Division of Gynecology and Perinatology, University of Maribor Clinical Center, Maribor, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Infectious and Non-Infectious Diseases Causing the Air Crescent Sign: A State-of-the-Art Review. Lung 2017; 196:1-10. [PMID: 29143119 DOI: 10.1007/s00408-017-0069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/05/2017] [Indexed: 01/15/2023]
Abstract
Aspergilloma, also known as mycetoma or fungus ball, is characterized by a round or oval mass with soft-tissue attenuation within a preexisting lung cavity. The typical computed tomography (CT) aspect of an aspergilloma is a mass separated from the wall of the cavity by an airspace of variable size and shape, resulting in the air crescent sign, also known as the meniscus sign. This CT feature is non-specific and can be simulated by several other entities that result in intracavitary masses. This review describes the main clinical and imaging aspects of the infectious and non-infectious diseases that may present with fungus-ball appearance, including pulmonary hydatid cyst, Rasmussen aneurysm, pulmonary gangrene, intracavitary clot, textiloma, lung cancer, metastasis, and teratoma, focusing on the differential diagnosis.
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Marchiori E, Nobre LF, Zanetti G. Textiloma: A forgotten diagnosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:366-367. [PMID: 27462010 DOI: 10.1016/j.rppnen.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- E Marchiori
- Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha do Fundão, CEP 21941-913 Rio de Janeiro, Brazil.
| | - L F Nobre
- Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang, s/n - Trindade, CEP 88036-800 Florianópolis, Santa Catarina, Brazil
| | - G Zanetti
- Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha do Fundão, CEP 21941-913 Rio de Janeiro, Brazil
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Pessôa FMC, de Melo ASA, Souza AS, de Souza LS, Hochhegger B, Zanetti G, Marchiori E. Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review. Lung 2016; 194:501-9. [DOI: 10.1007/s00408-016-9909-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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de Paula MCF, Escuissato DL, Belém LC, Zanetti G, Souza AS, Hochhegger B, Nobre LF, Marchiori E. Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis. Respir Med 2015; 109:1235-43. [PMID: 26094051 DOI: 10.1016/j.rmed.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 12/11/2022]
Abstract
A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging. Tumorlike conditions of the pleura are relatively rare compared with neoplastic lesions such as mesotheliomas and metastases. Imaging-based diagnosis of these conditions can be difficult due to the similarity of appearance. Thus, recognition of certain imaging patterns and interpretation of these patterns in the clinical context are important. Pleural endometriosis, thoracic splenosis, thoracolithiasis, foreign bodies, pleural pseudotumors and pleural plaques are significant examples of focal tumorlike conditions discussed in this article. Computed tomography is the mainstay imaging technique for the primary assessment of pleural disease, but other imaging methods, such as magnetic resonance imaging and positron-emission tomography, can be of great support in the diagnosis.
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Affiliation(s)
| | | | | | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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