Imaging of retained surgical sponges in the abdomen and pelvis

Gastrointestinal devices: common and uncommon foreign bodies

Devices for the gastrointestinal tract are widely available and constantly advancing with less invasive techniques. They play a crucial role in diagnostic and therapeutic interventions and are commonly placed by interventional radiologists, gastroenterologists, and surgeons. These devices frequently appear in imaging studies, which verify their proper placement, identify any complications, or may be incidentally detected. Radiologists must be able to identify these devices at imaging and understand their intended purpose to assess their efficacy, detect complications such as incorrect positioning, and avoid misinterpreting them as abnormalities. Furthermore, many patients with these devices may require MRI, making assessing compatibility essential for safe patient care. This review seeks to provide a succinct and practical handbook for radiologists regarding both common and uncommon gastrointestinal devices. In addition to textual descriptions of clinical indications, imaging findings, complications, and MRI compatibility, the review incorporates a summary table as a quick reference point for key information and illustrative images for each device.

Anterioposterior Views Coupled With Lateral Views Are the Best for the Intraoperative Radiographic Detection of Retained Surgical Sponges

INTRODUCTION

A retained sponge after spine surgery can cause serious medical complications and medicolegal problems. Intraoperative radiographs are commonly used to detect it. This study evaluated intraoperative radiographs under routine clinical conditions that most spine surgeons experience to detect retained sponges.

METHODS

In this prospective randomized clinical trial, two patient groups undergoing open posterior lumbar surgery were studied. In one, a sponge was intentionally present; in the other, none was present. Standard intraoperative lateral (LAT) and anteroposterior (AP) radiographs were acquired before closing. Radiographs were analyzed for sensitivity, specificity, inter- and intraobserver reliability for three viewing conditions: one LAT radiograph versus one AP radiograph versus one LAT and one AP X-ray (LAT+AP).

RESULTS

A total of 111 patients were included. Accuracy, interobserver reliability, and intraobserver reliability were best for LAT+AP (80%, 96%, and 96%, respectively). Sensitivity was best for LAT+AP (87%) and specificity was best for LAT (95%). Positive predictive value was best for LAT (94%); negative predictive value was best for LAT+AP (88%). The probability of being right is better for female sex (odds ratio 1.6), younger age (odds ratio 1.02), and higher BMI (odds ratio 1.06).

CONCLUSIONS

We recommend AP with LAT images rather than either an AP or a LAT image alone.

Artificial intelligence in the detection of non-biological materials

Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.

A perioperative overview of a retained surgical swab in spinal surgery: Case report and prevention protocol

INTRODUCTION

Retained wound swabs although classified as a 'never event' and well documented in many surgical specialties are uncommon in spinal surgery. The aim of this article is to highlight the perioperative circumstances of an incident of a retained surgical swab and present a prevention protocol, in an attempt to eliminate its incidence.

CASE REPORT

The perioperative management of a 53-year-old male undergoing spinal surgery in whom a surgical swab was retained is reported. In addition to existing safety procedures such as the World Health Organization checklist, a Retained Surgical Swab-Prevention Protocol was implemented in our hospital and is presented to eliminate the occurrence of this 'never event' occurring again.

CONCLUSION

Retained surgical swabs or instruments are rare in spinal surgery occurring mostly in the lumbar spine, during emergency and prolonged procedures in patients with high body mass index. Maintaining a high index of suspicion and utilising a prevention protocol will prevent further harm to the patient.

Case report:18F-2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography image findings of a dog with gossypiboma

A 13-year-old, spayed, female mixed breed dog that had previously undergone mastectomy and ovariohysterectomy was referred for evaluation of metastasis after surgery. 18F-deoxy-2-D-glucose positron emission tomography/computed tomography (18F-FDG PET-CT) was performed and a soft-tissue mass was observed in the abdominal cavity. The characteristics of the abdominal mass were assessed and screening for metastasis was done with follow-up 18F-FDG PET scans. Uptake of 18F-deoxy-2-D-glucose was higher in the peripheral region and lower in the center of the abdominal mass. Exploratory laparotomy was performed, and the removed abdominal mass was consistent with a gossypiboma, which is a retained surgical sponge composed of non-absorbable material with cotton matrix. This case report describes the characteristics of 18F-FDG PET-CT imaging in a dog with an abdominal gossypiboma, which has not been reported in the veterinary literature before.

Mesenteric textiloma early discovery in a 31-year-old female: A case report

INTRODUCTION AND IMPORTANCE

Textilloma or Gossypiboma refers as surgical sponges left behind in the surgical field during surgery. Although rare, occur commonly in practice and such cases are rarely encountered in the literature due to their under-reporting. A retained surgical sponge is an avoidable surgical complication that can lead to patient morbidity, mortality and profound medico-legal implications.

CASE PRESENTATION

We report a case of intra-abdominal textiloma discovered early in a 31-year-old woman who underwent cesarean section due to placenta previa.

DISCUSSION

This complication in our surgical practice is still relevant despite the popularization of the World Health Organization checklist.

CONCLUSION

The purpose of reporting this case is to awaken practitioners to be more vigilant and avoid such circumstances.

Addressing the important error of missing surgical items in an operated patient

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.

Intracranial Textiloma: Imaging Features and Literature Review

Background and Importance Intracranial textilomas are retained surgical sponges presenting as pseudomass lesions in postoperative patients usually with surrounding inflammatory reaction. Though rare, these are commonly misdiagnosed as postoperative hemorrhagic collections, abscesses, radionecrosis, or residual/recurrent mass lesions. We describe the imaging findings of intracranial textilomas diagnosed in four patients on follow-up postoperative imaging along with their characteristic imaging findings to help radiologists/neurosurgeons make accurate diagnosis.

Clinical Presentation One patient had chronic headache without any focal neurological deficits. Rest of the patients were asymptomatic at the time of presentation

Conclusion In postoperative scans, possibility of textilomas should be considered apart from residual/recurrent lesions, postoperative abscesses, or radionecrosis. Correct and timely diagnosis is important for further treatment planning and patient care.

MRI evaluation of bile duct injuries and other post-cholecystectomy complications

Laparoscopic cholecystectomy is one of the most common procedures performed each year and can be associated with various post-operative complications. Imaging is integral to diagnosis and management of patients with suspected cholecystectomy complications, and a thorough understanding of normal and abnormal biliary anatomy, risk factors for biliary injury, and the spectrum of adverse events is crucial for interpretation of imaging studies. Magnetic resonance cholangiography (MRC) enhanced with hepatobiliary contrast agent is useful in delineating biliary anatomy and pathology following cholecystectomy. In this article, we provide a protocol for contrast-enhanced MR imaging of the biliary tree. We also review the classification and imaging manifestations of post-cholecystectomy bile duct injuries in addition to other complications such as bilomas, retained/dropped gallstones, and vascular injuries.

Inflammatory reaction to BioGlue™ masquerading as recurrence in patients with endometrial cancer: A report of two cases

•

BioGlue™, a glutaraldehyde-based vessel sealant, can cause a foreign body reaction.

•

Vessel sealants may be used for IVC repair during endometrial cancer staging.

•

Foreign body reaction to BioGlue™ may look like a cancer recurrence on imaging.

•

It is important to note prior use of vessel sealants in assessing paraaortic recurrence.

Oh, My Gauze !!!- A rare case report of laparoscopic removal of an incidentally discovered gossypiboma during laparoscopic cholecystectomy

INTRODUCTION

The work has been reported in line with the SCARE criteria. The most common retained foreign body during surgery is woven cotton surgical sponge, which includes both laparotomy pads and smaller sponges. Sponges are easily retained because of their ubiquitous use, relatively small size and when soaked in blood, sponges conform to and can be difficult to distinguish from surrounding tissues. The problem of retained surgical sponge is known as gossypiboma, and also as 'textiloma', 'gauzoma' or 'muslinoma'. The number of preoperatively diagnosed cases treated by laparoscopic approach is rare in the literature and laparoscopic removal of incidentally detected gossypiboma with concomitant laparoscopic cholecystectomy is not yet reported in the literature.

PRESENTATION OF CASE

In 40-year-old female with caesarean section 5 years ago, now during elective laparoscopic cholecystectomy and umbilical hernia repair, an incidentally detected Gossypiboma was encountered. The Gossypiboma was safely excised by laparoscopic technique followed by laparoscopic cholecystectomy and open hernia repair.

DISCUSSION

Postoperative complications following surgery are common and mostly unavoidable but some like the gossypiboma are infrequent and avoidable. Most of them are asymptomatic and present in the body for a long period of time. However, once discovered these foreign bodies must be removed for which laparoscopy proves to be a better approach. Most of these cases also are under-reported due to medicolegal implications.

CONCLUSION

Gossypiboma is one of the preventable complications of surgery by the compliance of certain measures perioperatively. If detected incidentally, it can be safely managed laparoscopically with a shorter post-operative hospital stay and better cosmetic results.

Unusual Cause of Recurrent Cholangitis: Gossypiboma

Gossypiboma refers to a retained surgical sponge that can occur after any type of surgery. Though it is a rare complication of surgery, the retention of surgical sponges still occurs. We report a case of a 70-year-old woman who presented with recurrent upper abdominal pain and fever. She had a prior history of cholecystectomy and choledochoduodenostomy. Magnetic resonance cholangiopancreatography showed a filling defect in common bile duct. However, during endoscopic retrograde cholangiopancreatography and common bile duct clearance, clumps of woven fibres were removed suggestive of gossypiboma. 

Sonographic appearance of a soft-tissue gossypiboma in the forearm with pathologic correlation

We describe the sonographic, radiologic, and histopathologic appearances of a soft tissue gossypiboma in the forearm of an 81-year-old woman with a history of a radial fracture treated with an internal fixation surgery.

Gossypiboma: A Dramatic Result of Human Error, Case Report and Literature Review

Gossypiboma refers to a retained foreign object that was forgotten in the body cavity during an operation. It is a rare surgical complication that most commonly occurs after intraperitoneal abdominal emergency surgical procedures, but may also occur after virtually any type of operation. Gossypiboma can be confused with neoplastic lesions and abscess. Clinical examination and radiological findings may sometimes mislead the physician. We intend to present our cases, which is thought to be a kidney tumour and bladder cancer but resulted gossypiboma which is a condition that is caused by a forgotten sponge during the operation and it can mimic the cancer. During the operation, the team must work in coordination and be careful. Unnecessary operations in such situation can significantly increase the patient's morbidity.

In vitro Evaluation of Performance Properties of Sponge Hemostatic Dressings (Review)

Dressings for restoring organ defects and/or hemostasis in the injury site are being actively applied in operational units. These dressings are used in various surgeries and are widely represented in the foreign and domestic markets of medical products. Many local implants have different levels of hemostatic activity, which requires standardization of the algorithm of choice and the methods of their study. Here the methods of studying the performance properties of hemostatic implants in vitro have been considered and evaluation criteria of their physical, chemical and organoleptic properties in vitro have been proposed. This will allow a researcher to choose optimal variants of samples for further experiments on biological models more effectively as well as to save funds, time and reduce the number of experiments in vivo.

Medical imaging of textile iatrogenic foreign bodies in abdomen and pelvis

Aim. To systematize modern literature data on medical imaging of textile iatrogenic foreign bodies.

Materials and methods. We analyzed the articles about the identification of textile iatrogenic foreign bodies, published until 2019.

Discussion. Foreign body detection should be included in the differential diagnostic algorithm for patients who have a history of surgical interventions and unexplained symptoms. In all cases of suspected iatrogenic foreign body, it is desirable to use at least two available techiques of medical imaging: ultrasound, X-ray, MDCT, MRI.

Conclusions. Left foreign body entails medical and legal consequences that adversely affect both the reputation of the surgeon and the reputation of the medical institution, as they are considered a classic example of iatrogenic damage and indicate a violation of the quality standards of medical care. The article presents data on the features of medical imaging of textile iatrogenic foreign bodies left in the patient’s body as a result of planned and emergency surgical interventions, and determining the optimal tactics for examination and treatment of this category of patients.

Retained Surgical Items in Inguinal Canal: A Case Report and Literature Review

BACKGROUND:

Retained surgical items (RSI) are rare medical challenges with serious complications and medicolegal implications. Knowledge and preventive measures for these rare events are currently not sufficient to limit their increasing incidence. Gauzes and sponges constitute most of RSI. Forceps, needles and pins may be found too. Diagnosis of these events is challenging and often missed due to nonspecific clinical findings.

PRESENTATION OF CASE:

We present here a 49-year-old patient who presented to the clinic with a history of chronic scrotal sinus on the same side of a repeatedly repaired inguinal hernia 4 months before admission. He underwent exploration of the inguinal canal as elective surgery. Exploration of the inguinal canal revealed missed surgical gauze left during the previous hernia repair. The gauze was removed, and the inguinal canal was repaired. The postoperative period was uncomplicated.

CONCLUSION:

Retained surgical items are completely preventable near-events. Although they are rare entities, clinicians must have a high index of suspicion for any postoperative, in patients presenting with pain, sinus or palpable masses.

Practical Suggestions for Prevention of Complications Arising from Oxidized Cellulose Retention: A Case Report and Review of the Literature

BACKGROUND Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature. CASE REPORT A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a "neogallbladder". Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4 th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel ® Standard for hemostatic purposes. Results of 12-month follow-up were normal. CONCLUSIONS Herein, we report the first case of a complication associated with the use of Gelita-Cel ® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.

Intrapericardial gossypiboma: Rare cause of intrathoracic mass

INTRODUCTION

Gossypiboma is a retained surgical sponge inside our body after surgical intervention. It is most commonly found in abdominal cavity. Its occurrence in thoracic cavity as intrapericardial gossypiboma is extremely rare.

PRESENTATION OF CASE

We present a 25 year old male with complaint of chest pain for 1 year. He had a history of total correction of Tetralogy of fallot 14 years back, at another hospital. On clinical examination and investigations including contrast enhanced computed tomography (CECT) of thorax; diagnosis of right anterior mediastinal mass of germ cell tumor was made and planned for thoracotomy. On exploration, the gauze piece of 31 cm was removed from the pericardial mass and a final diagnosis of gossypiboma was made.

DISCUSSION

Although gossypibomas are commonly reported in abdominal and pelvic surgery but a prolonged operative time, untrained staff, poor communication in sponge count may favour the occurrence in thoracic cavity. A patient with intrathoracic gossypiboma usually presents with chest pain, dyspnoea, thoracic mass or fever. CECT and Magnetic resonance Imaging (MRI) are useful imaging modality in such cases. Surgical exploration with histopathological examination confirms the diagnosis of gossypiboma.

CONCLUSION

In a postoperative patient who presents with chest pain and intrathoracic mass, gossypiboma should be a differential diagnosis even it is rare to occur in thorax.

IMAGING DIAGNOSIS-COMPUTED TOMOGRAPHY FINDINGS IN A DOG WITH SPONTANEOUS TRANSMURAL MIGRATION OF A TEXTILOMA INTO THE CECUM

A 3-year-old spayed female dog was presented with 3-month history of severe bilateral uveitis subsequent to previous ovariohysterectomy. Physical examination revealed moderate abdominal pain. Computed tomography showed a nonobstructive heterogeneous mass-like lesion with a speckled gas pattern (spongiform pattern) within the cecum. Exploratory laparotomy revealed a surgical swab in the lumen of the cecum with severe adhesions. Histopathological examination demonstrated a chronic inflammatory pyogranulomatous reaction to the retained swab embedded within the intestinal wall, consistent with transmural migration of the swab from the peritoneal cavity into the cecum.

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.

A 20-Year-Old Retained Surgical Gauze Mimicking a Spinal Tumor: A Case Report

A 79-year-old man visited our clinic complaining of lower back and left leg radiating pain that began 1 month prior to his presentation. He underwent surgery for lumbar disc herniation 20 years ago at another hospital. Magnetic resonance imaging revealed left-sided foraminal stenosis at L4-5. In addition, a paraspinal mass occupying the L4 spinous process and left lamina was observed. We subsequently performed an L4-5 decompression and fusion. During the operation, retained surgical gauze with granulation tissue was found. The term gossypiboma is used to define a mass lesion consisting of retained surgical gauzes and an adjacent foreign body reaction. Gossypibomas are uncommon in the paraspinal area and are mostly asymptomatic in chronic cases. Because there are no specific clinical or radiological signs, they can be confused with other tumorous conditions. Gossypibomas should be included in the differential diagnosis of paraspinal soft-tissue masses detected in patients with a history of prior spinal surgery.

A Case Series on Gossypiboma - Varied Clinical Presentations and Their Management

Retained surgical sponges in the peritoneal cavities are an infrequent operative/surgical complication and an error which is avoidable. The unfortunate situation of forgotten or missed foreign bodies after any surgical procedure may lead to medico legal problems. Though gossypiboma can be found at any operative site but intraperitoneal cavity is the most frequent site reported in literature. Over a period of three years, June 2009-2012, we conducted retrospective analysis of case summaries of eight patients who underwent re-laparotomy for retained surgical sponge at our institute. Pre operative diagnosis was made in 7out of 8 patients, 5 of whom underwent re-laparotomy and one had sponge removed through the caesarean incision, while in another it was removed per-vaginum through the open vault (post hysterectomy). In one patient, gossypiboma was an incidental finding on laparotomy done for adnexal mass. There was no mortality in any of the cases.

Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intra-abdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosis-prior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4 ± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.

[Abdominal textiloma, about a case]

Le textilome, également appelé gossybipomas, est une complication postopératoire très rare. Il peut s'agir d'un corps étranger composé de compresse(s) ou champ(s) chirurgicaux oubliés au niveau d'un foyer opératoire. Ils sont plus souvent asymptomatiques, et difficile à diagnostiquer. En particulier, les cas chroniques ne présentent pas de signes cliniques et radiologiques spécifiques pour le diagnostic différentiel. L'anamnèse est donc indispensable pour le diagnostic vu que les signes cliniques ne sont pas concluants. Le cliché d'abdomen sans préparation est peu contributif, l’échographie est fiable. La tomodensitométrie permet un diagnostic topographique précis, mais ce n'est pas toujours le cas. Certaines équipes proposent des explorations par IRM. Nous rapportons un cas de textilome intra abdominal, chez une patiente de 31 ans opérée il y a 8 ans pour grossesse extra-utérine, chez qui la TDM abdomino-pelvienne a évoqué un kyste hydatique péritonéale sans localisation du foie. Traitée par extrait d'un petit champ de 25x15cm et adhérant au sigmoïde. Le but de ce travail est de mettre en évidence le problème de diagnostic de cette pathologie et l'importance de la laparotomie exploratrice.

Thoracic textilomas: CT findings

OBJECTIVE:

The aim of this study was to analyze chest CT scans of patients with thoracic textiloma.

METHODS:

This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus.

RESULTS:

The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%).

CONCLUSIONS:

It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.

Textiloma formation post endovascular repair of abdominal aortic aneurysm

We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient complained of claudication on the left side associated with persistent pain, rigid swelling on the left groin area, and occasional febrile episodes within the last month. Ultrasonography showed fluid collection, and needle aspiration gained pus. It was thought to be local postsurgical infection, and the patient got antibiotics, but he did worse. One month later, computed tomography revealed focal left common femoral artery (CFA) stenosis, edematous appearance of subcutaneous soft tissue in the left groin area, and anterior displacement of the ipsilateral CFA in relation to the right side. Surgical exploration of the region revealed retained, uncapsuled, and partially destroyed surgical gauze, lying just behind the left CFA, which was removed.

Radiographic Detectability of Retained Neuropatties in a Cadaver Model

BACKGROUND

Counts are the commonest method used to ensure that all sponges and neuropatties are removed from a surgical site before closure. When the count is not reconciled, plain radiographs of the operative site are taken to determine whether the missing patty has been left in the wound. The purpose of this study was to describe the detectability of commonly used neuropatties in the clinical setting using digital technologies.

METHODS

Neuropatties were implanted into the anterior and posterior cranial fossae and the thoracolumbar extradural space of a mature male cadaver. Four neuropatty sizes were used: 3 × 1 in, 2 × ½ in, ½ × ½ in, and ¼ × ¼ in. Neuropatties, with size and location chosen at random, were placed in the surgical sites and anteroposterior/posterior-anterior and lateral radiographs were taken using standard portable digital radiographic equipment. Six clinicians reviewed the digital images for the presence or absence of neuropatties. The readers were not aware of the number and size of the patties that were included in each image.

RESULTS

The detectability of neuropatties is dependent on the size of the neuropatty's radiopaque marker and the operative site. Neuropatties measuring 2 × ½ in and 3 × 1 in were detected reliably regardless of the operative site. ¼ × ¼ in neuropatties were poorly detected by neurosurgeons and radiologists in all three operative sites. Readers of various experience and background were similar in their ability to detect neuropatties under these conditions.

CONCLUSIONS

Under simulated operating room conditions and using currently available neuropatties and plain radiograph imaging technology, small ¼-in and ½-in neuropatties are poorly visible/detectable on digital images.

An extremely rare complication of varicose vein surgery: retained foreign body

Foreign body is among complications of surgery. But as a complication of varicose vein surgery it was reported extremely rarely and, to our knowledge, there is only one paper in the literature. A case with retained sponge which was detected five months after varicose vein surgery was presented.

Imaging of abdominal and pelvic surgical and postprocedural foreign bodies

Every form of medical and surgical treatment, even the most trivial one, carries with it some chance of complications. This risk is usually small, and the benefit of the treatment should clearly outweigh the risk. Treatment-related complications may occur, however, presenting either soon after the intervention or remote from it. In this review, the focus is on imaging findings of surgical materials used in abdominal surgery, and of a wide array of implanted abdominal devices. The pertinent complications of these devices and of retained surgical objects are highlighted and illustrated.

[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.

Colonic perforation by a transmural and transvalvular migrated retained sponge: Multi-detector computed tomography findings

Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction. Once passed through the ileo-cecal valve, a retained sponge can be propelled forward by peristaltic activity and eliminated with feces. We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation. On physical examination, a generalized resistance was observed with tenderness in the right flank. Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery. In addition, a ring-shaped hyperdense intraluminal material was also noted. At surgery, the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure, but no diverticula were found. A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.

Retained foreign bodies: a serious threat in the Indian operation room

Retained foreign bodies (RFBs) are a surgical complication resulting from foreign materials accidently left in a patient's body. This review attempts to give an overview of different types of RFBs, problems related to them and their management after the surgical operation. The internet was searched using the Google and Google scholar. In addition, relevant electronic journals from the University's library such as Entrez (including PubMed and PubMed central), Since Direct, Scirus, NIH.gov, Medknow.com, Medscape.com, Scopus, MedHelp.org, Cochrane library, WebMD.com, and World Health Organization Hinari. It shows that the major reasons of RFBs are emergency surgical operation with unplanned changes, patient high body mass index, and poor communication. To prevent this textile material should be radiopaque marked and must be counted once at the start and twice at the conclusion of all surgical procedures. If the count is incorrect, then radiography or manually re-exploration should be performed. Ultrasonography, computerized tomography, magnetic resonance imaging and radio frequency identification are also used in the proper identification of RFBs. Safety practice should be robust and simple enough to protect patient under the most chaotic of circumstances. Proper communication among the personnel participating in surgery aimed at preventing this medical negligence would help in mitigating such errors. Finally, the surgeon should not only follow the standard recommended procedure, but also report cases of RFBs.

A retained plastic protective cover mimicking malignancy: Case report

INTRODUCTION

Cases of retained foreign bodies during surgery are more frequently seen in developing countries. Following surgical procedures, unintentionally retained foreign bodies can cause serious complications, in addition to medico-legal issues.

PRESENTATION OF CASE

A 60-year-old man presented with abdominal cramps. He had previously undergone a laparoscopic radical right nephrectomy due to renal cell carcinoma. Abdominal tomography revealed a mass surrounding the main vascular structures with malignant features in the location of previously performed nephrectomy. Further evaluation of the mass was undertaken by PET/CT. Increased FDG uptake on the PET/CT scan suggested disease recurrence. Retroperitoneal lymph node dissection was performed. The dissection specimen was opened to determine the nature of the mass. Retained plastic foreign bodies were found. There were no malignant cells in the histopathological examination of the surgical specimen.

DISCUSSION

A granulomatous reaction which is mainly responsible for morbidity occurs around the foreign bodies due to the inflammatory response. These granulomas may cause confusion during patient follow-up, especially in those who have undergone major abdominal surgery due to cancer.

CONCLUSION

Following surgical resection for malignancy, unintentionally retained foreign bodies can produce a moderate increase in FDG uptake mimicking disease recurrence.

Beware of gossypibomas

Gossypiboma, a retained surgical sponge, is a rare complication that can occur after any type of surgery. Despite the precautions, the retention of foreign bodies still occurs. We describe a case of a 33-year-old woman with epigastric pain. She was initially diagnosed with acute cholangitis with choledocholithiasis. Although common bile duct stone was successfully removed endoscopically, her epigastric pain did not completely subside. She had undergone an emergency caesarean section at a suburban maternity hospital 6 weeks prior to the referral. A contrast-enhanced CT revealed an encapsulated mass showing a spongiform pattern with fluids and gas bubbles inside, and gossypiboma was suspected. A retained surgical sponge without radiopaque markers was removed surgically. Except for a wound infection, the postoperative course was uneventful. Gossypiboma should always be considered in the differential diagnosis of indeterminate abdominal pain, infection or a mass in patients with a prior surgical history.

Retained surgical sponge mimicking GIST: Laparoscopic diagnosis and removal 34 years after original surgery

The term gossypiboma denotes a cotton foreign body retained inside the patient during surgery, a rare surgical complication. The symptoms following this entity are non-specific, such as pain, palpable mass and fever, which make clinical diagnosis difficult. The computerized tomography (CT) scan is the most useful method for diagnosis; however, sometimes the preoperative diagnosis remains uncertain even after the imaging exam. In that case, laparoscopy arises as a valuable diagnostic tool, as well as a prompt treatment option. However, when diagnosis is made years after the original surgery, the laparoscopic approach becomes harder. Our patient presented without clear symptoms, remaining asymptomatic for 34 years. The CT scan presumptive diagnosis was a gastrointestinal stromal tumour, and laparoscopy was performed providing an accurate diagnosis and treatment in the same surgical time.

Surgicel® (oxidized regenerated cellulose) granuloma mimicking local recurrent gastrointestinal stromal tumor: A case report

Unexpected clinical and/or imaging evidence of the recurrence of gastrointestinal stromal tumors soon after surgical resection may be complicated due to certain biological behavioral features of gastrointestinal stromal tumors. However, local hemostatic materials routinely used in abdominal surgery to achieve hemostasis intraoperatively may cause a foreign-body reaction, which appears to be indistinguishable from recurrent tumors in imaging studies. Thus, a second examination may be necessary to settle the true nature of the findings in such cases. If the resection and examination reveals a recurrent tumor, further proper oncological treatment is warranted, whereas if a foreign-body reaction is observed, radical or potentially harmful therapy may be withheld or cancelled. The present study retrospectively analyzes the case of an 83-year-old male patient who presented with a recurrent gastrointestinal stromal tumor four months after surgical resection, which was later identified as an intra-abdominal foreign-body granuloma caused by retained Surgicel^® residue. The present study aimed to demonstrate why foreign-body granuloma induced by local hemostatic materials should be incorporated into the differential diagnosis of recurrent gastrointestinal stromal tumors post-operatively, particularly soon after surgical resection has been performed.

Gossypiboma mimicking gastrointestinal stromal tumor causing intestinal obstruction: a case report

A 41-year-old woman was admitted to our hospital with abdominal pain that developed about 1 year after a Cesarean section. Pelvic computed tomography (CT) revealed diffuse dilation of the small intestine with fluid shadows and a pelvic tumor 55 mm in diameter. The density of the tumor, which was not enhanced by intravenous contrast medium, was diffuse and similar to that of muscular tissue, whereas the density of a capsule surrounding the mass was relatively high. T1- and T2-weighted pelvic magnetic resonance imaging (MRI) of the tumor revealed the same diffuse low-intensity signals as muscular tissue, and diffuse high-intensity signals, respectively. The CT and MRI findings were consistent with those of a gastrointestinal stromal tumor (GIST) causing ileus of the small intestine. As inserting an ileus tube did not improve her symptoms, the patient was scheduled for tumor resection. The operative findings revealed a hard, solid tumor adhering to the surrounding small intestine. The macroscopic findings revealed that the tumor consisted of layers of stratified gauze surrounded by a thick granulomatous wall. The gossypiboma was considered to have originated from gauze that had been left behind after the Cesarean section. If a patient has a history of surgery, the possibility of gossypiboma should be considered when CT or MRI findings indicate features of GIST.

[Abdominal textiloma: report of a case]

Le textilome est une complication postopératoire très rare mais bien connue. Il peut s'agir d'un corps étranger composé de compresse(s) ou champ(s) chirurgicaux laissés au niveau d'un foyer opératoire. La découverte du textilome abdominale est généralement tardive. L'anamnèse est donc essentielle pour diagnostic vu que la clinique n'est pas concluante. La clinique associe des troubles chroniques du transit à des syndromes sub-occlusifs, le cliché d'abdomen sans préparation est peu contributif. L’échographie est fiable. La tomodensitométrie permet un diagnostic topographique précis. Certaines équipes proposent des explorations par IRM. Nous rapportons un cas de textilome intra abdominale, chez une patiente opérée 6 mois auparavant d'un fibrome utérin.

Avaliação por imagem dos gossipibomas abdominais

O termo gossipiboma é usado para descrever uma massa formada a partir de uma matriz de algodão cercada por uma reação inflamatória/granulomatosa. Sua incidência é estimada em 0,15% a 0,2%. O corpo estranho na cavidade abdominal pode servir de nicho para a proliferação de microrganismos e agir como foco primário para formação de abscessos e de peritonite. Vários estudos têm demonstrado a importância da correlação clínica com os diversos métodos de imagem (radiografia convencional, ultrassonografia, tomografia computadorizada e ressonância magnética) no diagnóstico dos gossipibomas. Este ensaio tem por objetivo demonstrar uma série de casos típicos de gossipibomas abdominais e ilustrar suas diversas formas de apresentação, com ênfase nos achados dos diferentes métodos de imagem, visando a familiarizar os radiologistas com esta enfermidade e seus principais diagnósticos diferenciais.

Foreign objects encountered in the abdominal cavity at CT

Foreign objects are not infrequently seen at computed tomography (CT) of the abdomen and pelvis and may pose a diagnostic challenge to the radiologist, who must recognize the object, characterize its nature and location, and determine its clinical significance. Most foreign objects are incidentally detected at CT, but they may mimic a wide range of pathologic conditions. Some foreign objects (eg, an object that has been swallowed either intentionally or unintentionally) are the cause of the patient's signs and symptoms and require prompt medical attention. Other objects, such as a sponge or surgical instrument that has been retained postoperatively, may have medicolegal consequences. Furthermore, certain objects, such as intentionally concealed drug packets, may go undetected unless a high degree of suspicion exists and appropriate window settings are used to review the study. The radiologist should be familiar with the wide range of foreign objects that may be encountered at abdominopelvic CT, be able to recognize them promptly, and understand their implications for patient treatment.