Negligence to nightmare: Gossypiboma


INTRODUCTION: Gossypiboma describes a mass within a patient’s body comprising a cotton matrix surrounded by a foreign body granuloma due to retained pieces of gauze; is an infrequent surgical complication & serious surgical malpractice resulting from negligence. Either detected early due an exudative inflammatory reaction with the formation of an abscess or can present late as a mass due to aseptic fibrotic reaction to the cotton material.

CASE REPORT: First case was that of a 45 year old male presenting with pain abdomen & vomiting after an open cholecystectomy done 2 months back and on laparotomy a surgical sponge was retrieved from jejunal lumen. Second is a female patient 45 yr old who had fever and purulent discharge P/V 3 months after a vaginal hysterectomy and a gauze was found in the POD on opening the vaginal vault. Third was also a female 36 year old with pain in epigastrium, vomiting & occasional rise of temperature, following open cholecystectomy 3months back. After endoscopic confirmation of a foreign body a square size surgical sponge was removed from the duodenum via laparotomy. The fourth one being the most interesting one where a 29 yr old female after a LSCS for a twin pregnancy complained of mild lower abdominal pain and constipation and while she had been planned for a cholecystectomy and repair of a divarication of recti, an accidental injury to the small bowel during first umbilical trochar entry led to discovery of a surgical sponge in the bowel lumen partially obstructing it.

DISCUSSION: Despite all considerations during operation the incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 70-80%; only a third being correctly diagnosed. Symptoms either relate to recurrence, occlusion or septic changes. With an infrequent incidence & frequent misdiagnosis, this surgical malpractice is easily avoidable by mere watchfulness of the surgeon and rest of the OT staff. Simply keeping the sponge count and thorough exploration of the operative field before & after the procedures and use of surgical textiles impregnated with radiological markers would not only spare the patient of unnecessary morbidity but also the surgeon of serious medicolegal consequences.

CONCLUSION: Though a rarity it must be suspected in every post operative case presenting with pain, obstruction etc. once confirmed gossypiboma is best removed by open surgery though laparoscopic and percutaneous removal has been reported in few selected cases.

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