Gossypiboma, the Never Event;a Case Report

Introduction and importance: In the surgical field, we utilize gauze and surgical instruments daily, and the complications can be divided into avoidable versus nonavoidable. The term Gossypioma in the literature indicates a retained surgical sponge or gauze. It can be there for years and be dormant or discovered within days as the patient starts to reveal symptoms. This makes diagnosing challenging pre-operatively as the radiological findings might not be as specific. Case presentation: A 75 male Moroccan patient with Normal Body mass index, Medically free. His main complaint was Abdominal pain in the epigastric area. His past surgical history was positive for a left open inguinal hernia repair with mesh three months ago that went uneventfully And an open appendectomy before 20 years. The Abdomen X-ray: multiple air-fluid levels with dilated small bowel as well as perfectly rounded calcifications at the right lower quadrant. Conclusion: It’s a devastating medical error, but it can be avoidable. Communication between the surgical team and operation staff is a crucial and straightforward tactic to prevent these complications. As the sequel will reveal itself at any time and the patient will pay the price.

Gossypibomas as a rare cause of common bile duct dilation

Gossypibomas are any foreign bodies left inside the patient after an operation. It represents a diagnostic challenge in clinical practice because the clinical consequence may manifest in different forms immediately, months, or even years after the surgical procedure.

Under-reporting of gossypiboma in a third-world country. A sociocultural view

The paper looks at the reason for the low reportage of retained abdominal packs following an abdominal operation in a third world country like Nigeria. It is generally agreed that this unfortunate situation is under-reported. The reason for under-reporting is now given a socio-cultural perspective. Fear of litigation does not seem to be paramount here like it would be in the western (developed) world. Other explanations like fear of being made a scapegoat for something which may be due to spiritual attacks may be more important. The paper concludes by recommending that the removal of impediments to disclosure of this adverse surgical event will lie in education, discouragement of scapegoatism and improvement in hospital services in the third world.

Gossypiboma Presenting as an Atypical Intra-Abdominal Cyst: A Case Report

Gossypibomas are generally retained surgical sponges, and are usually a rare occurrence. They are diagnostic dilemmas with an incidence ranging from 1 in 8000 to 1 in 18,000 surgeries. However the incidence of this problem is on the rise and the clinician needs to have a high index of suspicion to make an accurate diagnosis. We reported the case of a 50-year-old male patient who presented with a 6-month history of vague epigastric discomfort, early satiety and nausea. Further investigation revealed an intra-abdominal cyst that proved to be secondary to a retained laparotomy sponge and was treated laparoscopically. This is usually an unanticipated surgical misadventure which is often preventable, with significant associated stigma for the surgical professional involved. Unfortunately it leads to extensive and often unnecessary surgical intervention. The condition can be managed conservatively or surgically. Our case report demonstrates the use of laparoscopy for the successful management of intra-abdominal gossypibomas and represents the first reported case of laparoscopic management of a gossypiboma in the Caribbean setting. It also demonstrates both the acute and delayed presentations of gossypibomas in the same patient.

Abdominal Gossypibomas: Computed Tomography Scanner Findings of a Series of 15 Cases

Background: “Gossypiboma” or “textiloma” refers to accidental retention of textile material in an operated area of the body. Abdominal surgery is most often responsible for this complication. The purpose of our study was to describe the appearance of abdominal gossypibomas on computed tomography (CT) scan images. Materials and Methods: We conducted a retrospective study over ten years (from January 1, 2009 to December 31, 2018) at the Teaching University Hospital of Lomé. We collected all surgically confirmed cases of abdominal gossypibomas with abdominal CT scans. Results: Fifteen cases were compiled, with a sex-ratio of 0.36. The average age of the patients was 34 years. The initial surgery was emergent in nine of 15 cases, 11 of which consisted of gynecological interventions. The gossypiboma symptom incubation period was between 3 days and 3 years. A radiopaque marker was observed via CT scans in three of 15 cases. The gossypiboma appeared encapsulated and spongiform in six cases and cystic in seven cases. There were two cases where the gossypiboma migrated into hollow organs. Conclusion: Abdominal gossypibomas appear polymorphic on CT scans and should be considered in patients who present with an abdominal mass and a history of abdominal surgery, even for absent radiopaque markers.

Calcified reticulate rind sign:A characteristic feature of gossypiboma on computed tomography

We herein report a gossypiboma resulting from a retained surgical swab, which had been left in peritoneum for 20years after appendectomy. CT revealed a cystic mass with a calcified reticulate rind. Subsequent surgery and pathological examination showed a gossypiboma. A simple experiment, using a barium-soaked surgical swab demonstrating similar CT appearance, supported our postulation that calcium deposition on the reticulated fibers of a surgical swab could generate such a characteristic 'calcified reticulate rind' sign. We believe that identification of this CT sign facilitates the diagnosis of gossypibomas.

Surgical intervention may not always be required in gossypiboma with intraluminal migration

Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.

Report of gossypiboma from the standpoint in medicine and law

We report on a case of gossypiboma. A 78-year-old man was admitted to our hospital with acute abdomen. He had undergone an operation for colon cancer 4 mo previously.Abdominal ultrasonography revealed an echogenic lesion with a hypoechoic rim and strong posterior acoustic shadowing in the lower abdomen. Diagnosis of gossypiboma can be made by ultrasonography to avoid loss-of-chance of survival. We reviewed the English literature briefly of gossypiboma from the medical and juridical view. According to the theory of loss-of-chance, the damage of plaintiff is the loss of the chance of survival or recovery, rather than the final harm. The victim would allow recovery for the loss of the chance from the defendant. But the plaintiff would show by a preponderance that he was deprived of a betterchance of a cure. Under the proposed rule, the compensable value of the victim would be the plaintiff's compensation for the loss of the victim's chance of survival.

腹腔无金属标记纱布瘤CT诊断、误诊分析及文献复习

目的探讨腹腔无金属标记纱布瘤的CT表现,分析术前误诊原因,以提高对本病的认识。方法回顾性分析经手术及病理证实的4例腹腔无金属标记纱布瘤患者的临床资料,均行CT平扫、增强扫描,并行多平面重组(MPR)图像处理,复习相关文献。结果本组无金属标记纱布遗留腹腔时间为3个月～8年。1例术前误诊为小肠肿瘤,2例术前误诊为胃肠道间质瘤,1例误诊为乙状结肠炎症。其中小肠与肿块相互包绕2例,小肠穿孔、纱布包块嵌入小肠内1例;小肠、乙状结肠穿孔合并阑尾炎、双侧输卵管积脓1例。结论纱布瘤是少见的医源性异物肉芽肿,CT是重要诊断手段之一,特别是无金属标记纱布瘤误诊率高,仔细分析其影像征象,减少误诊,提高术前诊断率,具有重要的诊断意义。

腹腔纱布肉芽肿的MSCT征象分析

目的：总结分析腹腔纱布肉芽肿的典型及不典型MSCT征象。方法：回顾性分析经手术病理证实的5例腹腔纱布肉芽肿的临床及影像学资料,所有患者均行腹部MSCT平扫及增强扫描。结果：5例患者纱布遗留在腹腔的时间为2.5个月~8年。5例中有3例纱布肉芽肿移位至腹腔脏器内,其中远段回肠1例,十二指肠球部及胃窦部1例,乙状结肠内1例;余2例纱布肉芽肿位于腹膜腔,其中1例位于左下腹,1例位于右上腹。5例均表现为类圆形或卵圆形肿块影,周围均可见厚薄不均的软组织构成的壁,其中2例可见金属标记,3例内部呈＂蜂窝征＂,1例呈＂类漩涡征＂,1例呈＂漂浮征＂,2例呈＂血管卷入征＂。结论：MSCT增强扫描可为腹腔纱布肉芽肿的诊断提供重要依据,＂蜂窝征＂是其典型CT表现,另外还可见＂类漩涡征＂、＂漂浮征＂、＂血管卷入征＂、＂钙化网状外壳征＂等不典型征象。

Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy

Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications.

腹腔纱布瘤的MSCT诊断与鉴别诊断(附14例分析)

目的探讨腹腔纱布瘤的MSCT表现,旨在提高对该病的诊断和鉴别诊断水平。方法回顾性分析经手术病理证实的14例腹腔纱布瘤的MSCT表现及临床资料,并结合相关文献复习。结果14例腹腔纱布瘤,男性6例,女性8例,上腹部3例,下腹部7例,盆腔4例,其中表现为实性肿块5例,表现为囊实性肿块8例,表现为囊性肿块1例;MSCT上可见蜂窝征5例,飘带征4例、海绵征1例,网状壳样钙化征2例,不典型表现2例;CT增强动脉期肿块呈明显不均匀强化8例,轻度不均匀强化2例,中度不均匀强化4例,所有14例均表现为延迟强化。结论腹腔纱布瘤的MSCT表现具有一定的特征性,其中蜂窝征、飘带征、海绵征、网状壳样钙化征是其特征性表现,熟悉腹腔纱布瘤的临床特征及MSCT影像学表现有助于提高对该病的诊断和鉴别诊断水平。