Ultrasonographic appearance of retained surgical sponges and gauzes in the acute postoperative period: a phantom and cadaveric study.

Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The purpose of this two-part, prospective, descriptive study was to describe the previously uncharacterized ultrasonographic appearance of RSS in phantom and cadaveric models of the acute postoperative period (24-48 h). For the first part of the study, a gelatin phantom containing a woven gauze with a radiopaque marker (radiopaque gauze), a woven gauze with no marker (nonradiopaque gauze), and a laparotomy sponge with a radiopaque marker (radiopaque sponge) was evaluated with ultrasonography. For the second part of the study, a total of 23 gauzes and sponges (of the aforementioned three types) were placed within the peritoneal cavity of 20 cadavers in one of three randomized locations during an exploratory laparotomy laboratory. The cadavers were imaged with ultrasonography 17 h later and still images and video clips were reviewed. The retained surgical sponges and gauzes in the gelatin phantom displayed multiple hyperechoic layers and variable degrees of distal acoustic shadowing. In cadavers, 100% (23/23) of the retained surgical sponges and gauzes displayed a single hyperechoic layer of variable thickness and distal acoustic shadowing. In 95.6% (22/23) retained sponges and gauzes, there was a thin hypoechoic layer noted superficially to the hyperechoic layer. An improved understanding of the ultrasonographic appearance of retained sponges or gauzes in the acute postoperative period may assist in the identification of these objects.

Preventable morbidities of a successful intervention, Textiloma/Gossypiboma: A case series.

Preventable morbidities are serious conditions that have the potential to cause serious harm or death of the patient. One of the preventable morbidities is Gossypiboma or involuntary leaving of surgical sponge inside the body. The implication for the patient and the surgeon is grave. Gossypiboma is preventable if guidance and safety recommendations are followed. The purpose of presenting this case series is to rekindle awareness of the phenomena of Gossypiboma, highlight the implications, and stress prevention. Data of patients presented in the Lahore General Hospital was collected, which includes their demographic, clinical features, and management outcome. Their age, gender, surgery conducted, onset of symptoms, and salvage procedure were noted. Five cases are included in this case series from which it was concluded that Gossypiboma is encountered most commonly after intra-abdominal operation. Women are at increased risk during obstetric and gynaecological operations, though both genders are affected.

Surgical items retained in the abdominal cavity in diagnostic imaging tests: a series of 10 cases and literature review.

Despite improvements in the safety of surgical procedures, leaving a foreign object in a patient's body is still one of the complications of surgical procedures. The literature lacks an analysis of the effectiveness of specific diagnostic tests in detecting foreign objects. The authors present a discussion of the effectiveness of selected techniques and examples of the appearance of foreign bodies in radiological images based on the description of 10 cases. Leaving surgical haemostatic material in the abdominal or pelvic cavity is an underestimated phenomenon that poses a serious diagnostic problem. Computed tomography is the most sensitive method for detecting a foreign body, while a chest or abdominal X-ray is the simplest and most effective way to identify the surgical material. Ultrasound, although widely available, has not shown utility in diagnosing foreign bodies in our cases. Awareness of this problem is necessary to avoid unnecessary mortality in surgical patients.

Gossypiboma mimicking recurrent mandibular tumor: case report.

Gossypiboma is not a commonly known surgical complication. It is a tumorous lesion usually caused by hemostatic material used in surgery. Such lesions are most commonly described after abdominal surgery. In this case report, the authors describe a case of a 17 year old female patient, operated for a mandible tumor. Histopathologically it was an ameloblastoma. The patient was treated lege artis, with the use of Surgicel® felt (Surgicel FibrillarTM Absorbable Hemostat). After two months, the young woman returned to clinics with a tumorous lesion at the same location. On the CT scan the lesion appeared to be a recurrence of the originally diagnosed ameloblastoma. Histopathologically, the lesion consisted of a foreign material with surrounding granulation tissue and massive inflamation. The foreign material had an atypical structure. Subsequent consultations and consensus at the clinic confirmed that it was a haemostatic foreign material with a surrounding hyper-inflammatory response mimicking a tumor, known in the literature under various names, most often as gossypiboma or textiloma.

[Diagnosing textiloma post-surgery]. / Savoir évoquer le diagnostic de textilome en post-opératoire d'une chirurgie.

During care follow-up, specifically local post-operative care, nurses closely monitor the surgical site both for healing and for local, regional or general risk of infection. In this context, they are on the front line of identifying and reporting any suspicious clinical conditions. We use the example of a patient who presented with textiloma following orthopaedic shoulder surgery.

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.

Gossypiboma diagnosed fifteen years after a cesarean section: A case report.

Gossypiboma, a retained surgical sponge, is a rare complication following any surgical procedure and is primarily a result of human error. Such patients often have vague clinical presentations and the diagnosis often comes as a surprise. We present the case of a 40-year-old woman who had a long-standing history of lower abdominal discomfort. She was diagnosed with a gossypiboma fifteen years after a cesarean section. All general physicians, surgeons and radiologists must be aware of this rare but clinically significant entity.

Gossypiboma migration into the bladder.

Gossypiboma is a dreaded complication following mainly abdomino-pelvic surgeries. The clinical presentation varies widely and is strongly associated with two factors: localization of the textiloma and type of the tissue reaction. Intravesical gossypiboma migration is rare and usually presents as recurrent urinary tract infections. We report a case of gossypiboma migration into the bladder that was treated by endoscopic extraction. The purpose of this report is to remind the importance of the prevention which must be the challenge rather than the treatment modalities.

Endoscopic management of a transgastric migrated gossypiboma: A case report.

Textiloma, also known as gossypiboma, is a rare but well-documented entity. It involves the omission of surgical material during surgery. Gossypiboma remains a diagnostic dilemma to this day, due to its wide spectrum of clinical symptoms and numerous radiological pitfalls. The recommended treatment for gossypiboma is surgical removal. Endoscopic removal has been performed by some teams and has shown satisfying results. We report the case of a 33-year-old woman with a transgastric migrating gossypiboma, managed by an endoscopic extraction.

Transgastric migration of retained intraabdominal surgical sponge: Gossypiboma in the fundus.

The retention of a surgical sponge is a rare complication that presents diagnostic challenges and carries the risk of potential complications. Two distinct foreign body reactions, fibrinous, and exudative, can result in the formation of a granuloma (known as gossypiboma) or lead to complications such as abscess formation and migration into the gastrointestinal tract. In this report, we present the case of a 33-year-old woman with a history of splenectomy who presented with symptoms including epigastric pain, vomiting, and episodes of hematemesis. Imaging studies, including computed tomography and magnetic resonance imaging, revealed a mass consistent with a gossypiboma that had migrated transmurally into the stomach. The diagnosis was subsequently confirmed through gastroscopy, and successful endoscopic removal of the retained surgical sponge was performed.

Gossypiboma of renal compartment: A case report.

INTRODUCTION: Textiloma is a rare surgical complication. The location in the renal compartment is exceptional. The diagnosis can be difficult due to its rarity and the absence of clinical signs. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure. PRESENTATION OF CASE: We present a case report of a 71-year-old female patient with a high blood pressure under treatment. In this history, we noted a right nephrectomy by a lombotomy 6 years ago indicated for a mute kidney on a pyelo-ureteral junction syndrome and a drainage of a suppuration of this renal compartment a year after surgery. The patient was diagnosed with purulent discharge through the lombotomy site associated with lower back pain that had been present for 4 years. The patient then underwent an uro-CT scan which showed an oval formation of the right renal compartment suggestive of a textiloma. An exploratory right lombotomy was performed. And then the wetraction of the compresses followed by washing and closing had been done. The postoperative course was simple. DISCUSSION: The location in the renal compartment is exceptional. These may include compresses, surgical gauzes, sponges, cotton pads, etc. The inflammation caused by this foreign body will be responsible for an abscess in the event of infection. An evolution towards chronicity follows as long as the foreign body persists. Diagnosis and reoperation are often made during the same hospitalization period. Early imaging will help to make early diagnosis avoiding diagnostic wandering. The diagnosis was made late in our observation. However, the diagnosis can be difficult due to its rarity and the absence of clinical signs. CONCLUSION: Textiloma is a rare surgical complication. Renal localization, although rare, is "exceptional" of consequence. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure.

Management of abdominal textilomas: A retrospective study.

INTRODUCTION: Textilomas are an infrequent but well-known surgical complication. The authors report a series of cases to describe the frequency of abdominal textilomas, the circumstances in which they occur, their clinical and morphological characteristics, and their management, to contextualise these data, which may serve as a basis for preventive measures. SETTING AND METHOD: This was a monocentric, retrospective, descriptive study conducted over 10 years at a tertiary hospital. The circumstances of the initial intervention, the diagnosis, and the treatment of textiloma cases treated in the said centre were documented. RESULTS: Twenty-one (21) cases of abdominal textiloma were collected, with an annual frequency of 2.1 cases/year. The cases were predominantly female, with a female-to-male sex ratio of 1.62. The median age of the patients was 37 years. The initial operation was performed in a public facility in 80.95 % of cases. Myomectomy was the main indication (23.81 %). The time for signs to develop before consultation was 16.47 ± 8.82 days. Textiloma extraction was performed in an emergency in 61.90 % of cases. We noted morbidity (38.10 %) and mortality (9.52 %) in our patients. CONCLUSION: Textilomas are a rare surgical complication, albeit with a high morbidity and mortality rate. Their clinical polymorphism and the difficulties of diagnosis and management mean that prevention is of prime importance.

Case report: Transmural migration of a gossypiboma with secondary cystolithiasis and urethral obstruction.

This report describes a case of transmural migration of a gossypiboma from the peritoneum into the urinary bladder in a 4-year-old, female spayed, mixed-breed dog. The dog was presented on an emergency basis for complete urethral obstruction with radiographic evidence of urocystolithiasis. An exploratory laparotomy was performed and a 4-5 cm mass was identified which was confluent with the apex of the urinary bladder. The mass and bladder were exteriorized and isolated, and an apical, partial cystectomy was performed to remove the mass and gain access to the uroliths within the lumen of the bladder. A 4×4 surgical sponge was identified within the trigone of the bladder, it had multiple uroliths; another sponge was also found within the mass itself. This case demonstrates an atypical cause of urethral obstruction and serves as the first reported case of transmural migration of a gossypiboma into the urinary bladder of a dog. It also illustrates the importance of establishing routine operating procedures including gauze counts and the use of radiopaque-labeled surgical gauze.

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.

Endoscopic removal of a transgastric migrated textiloma: a case report.

Aim: Abdominal textiloma is an uncommon postoperative complication which can result in a fistula with luminal migration in the digestive tract. Surgery has been the mainstay method for textiloma removal; however, removal of retained gauze by upper gastrointestinal endoscopy is possible avoiding reoperation. Case report: We report a case of an abdominal textiloma in a 38-year-old male, which migrated into the stomach and was extracted by upper endoscopy. Conclusion: Endoscopic extraction after a luminal migration of the abdominal textiloma in the digestive tract facilitate its management and could avoid surgery.

The diagnosis of abdominal textiloma must be considered in front of unexplained symptoms in patients with a surgical history. Surgery has been the mainstay method for textiloma removal; however, endoscopic removal may be the best option which avoids reoperation. We report a case of an abdominal textiloma in a 38-year-old male, which migrated into the stomach and was extracted by upper endoscopy.

Textiloma complicating myomectomy: A case report.

INTRODUCTION AND IMPORTANCE: Textiloma or gossypiboma is a rare complication of pelvic surgery. It can mimic both, clinically, and radiologically an abscess, or a tumor, thus, making its diagnosis difficult and late. It can lead to a high morbidity and mortality rate for the patient and engages the surgeon's civil liability. CASE PRESENTATION: We report a case of textiloma following a myomectomy in a 42 year old patient treated in our department. Textiloma was diagnosed three years after myomectomy. Treatment consisted of a second laparotomy to remove the textiloma without complication. DISCUSSION: Incidence of textiloma varies from 1/833 to 1/32.672 but more often encountered in African surgical practice. Systematic counts of instruments, sponges and needles is not yet usual in our operating room. Through the analysis of this case, we call on surgeons to be more vigilant in order to avoid this serious medical error. CONCLUSION: The aim of this study was to describe the intraoperative errors that led to the occurrence of the textiloma, depict the diagnostic difficulties of textiloma, and the medico-legal implications in a tertiary hospital in Niger.

MRI of Paraspinal Gossypiboma: Look for the Barium Sulfate Filament.

Gossypiboma is a rare post-surgical complication comprising a retained surgical gauze surrounded by a foreign body reaction. Although usually presenting on magnetic resonance imaging (MRI) with low T1 signal, high central and low peripheral signal on T2, and bandlike peripheral enhancement, MR appearance is often non-specific. The barium sulphate filament within a surgical gauze presents on MR as a curvilinear thread which is dark on both T1 and T2 sequences. Scrutinizing the MR images is critical to identify the filament and to pinpoint the diagnosis of gossypiboma. Teaching Point: A paraspinal mass on postoperative spine MRI should be carefully searched for a hypointense contorted wire (the barium sulfate filament), as it may be the characteristic finding to evocate the diagnosis of gossypiboma.

Intravesical Textiloma: A Rare Complication Following Laparoscopic Inguinal Hernia Repair - A Case report.

Introduction: Today, surgical errors are becoming less and less frequent, thanks to the development of new techniques and the choice of different approaches. Nevertheless, they are still possible, and it is important to mention them in order to prevent them and avoid their recurrence. Case Presentation: We report a case of intravesical textiloma, rarely observed in urological surgery, in an 80-year-old patient who underwent laparoscopic inguinal hernia repair and presented to a urological consultation with hematuria and irritative lower urinary tract signs. Abdominal ultrasound revealed a hyperechoic tissue-like formation in the posterior wall of the bladder. The diagnosis of a bladder tumor was therefore raised, and cystoscopy was performed, which revealed an intravesical textiloma. All foreign bodies were removed endoscopically, and the patient had a good post-operative outcome. Conclusion: The rarity of the urological location of textilomas and the importance of their prevention remain a goal in surgery, whatever the specialty.

Surgical Management of Gossypiboma: A Case Report.

Gossypiboma is a rarely reported surgical complication and refers to a retained surgical textile in the body after a procedure. The surrounding inflammation and reaction often manifest as acute pain and subsequently require additional surgery. We report the case of a 33-year-old female who presented with acute abdominal pain one month after undergoing an exploratory laparotomy secondary to a gunshot wound in her home country. A diagnosis of retained foreign body was made with radiological imaging and confirmed upon the retrieval of two surgical sponges after the operation. Due to the high morbidity and mortality as well as increased healthcare costs, strict protocols must be followed to avoid such outcomes.

Paraspinal Gossypiboma (Textiloma) Mimicking a Soft Tissue Tumor.

Paraspinal textilomas are dreaded complications of spinal surgery and rarely reported in view of the medico-legal problems they may create. As many of them are asymptomatic and most are unreported, their true incidence is unknown. They must be kept in mind when re-operating for any mass lesion seen on magnetic resonance imaging in the vicinity of a previously operated spine. We present the case of a 40-year-old man found to have a textiloma as a result of a previous surgery, describe his imaging and histological findings, discuss the causes that might lead to the same, and enumerate preventive strategies to avoid such a complication.