Common Path and Consequences of Retained Surgical Sponge inside Abdomen Following Operation: An Inadvertent But Avoidable Scenario

Special Article - Gastrointestinal Bleeding

Austin Hematol. 2020; 5(1): 1029.

Common Path and Consequences of Retained Surgical Sponge inside Abdomen Following Operation: An Inadvertent But Avoidable Scenarios

Faruquzzaman*

Department of Surgery, Khulna Medical College Hospital, Bangladesh

*Corresponding author: Faruquzzaman, Department of Surgery, Khulna Medical College Hospital, Bangladesh

Received: May 04, 2020; Accepted: May 26, 2020; Published: June 02, 2020

Abstract

Surgical mop or sponge retained in the abdominal cavity following surgery is a serious but avoidable complication. The condition may manifest either as an exudative inflammatory reaction with formation of abscess, or aseptically with a fibrotic reaction developing into a mass. Intraluminal migration into intestine is not also rare finding. Gossypiboma or textiloma is referred to as a surgical gauze or towel or sponge inadvertently retained inside the abdomen following surgery. It has adverse surgical and medicolegal consequences including mental agony, humiliation, huge monetary compensation and imprisonment on the part of the surgeon and increased morbidity, mortality and financial loss on the part of the patient. Here three cases of gossypiboma are to be presented along with some relevant statistics.

Keywords: Gossypiboma; Textiloma; Retained mop; Retained sponge

Introduction

Surgical sponge or mop inadvertently retained in the abdominal cavity postoperatively is a serious but avoidable complication. Gossypiboma, term derived from the Latin “gossypium” (cotton) and the Swahilli “boma” (place of concealment) [1] is the term for retained surgical sponge. Two usual responses to retained mops are exudative inflammatory reaction with formation of abscess, or aseptic with fibrotic reaction to develop a mass [2]; intraluminal migration is relatively rare, leading to obstruction. Patients develop symptoms of abdominal pain, nausea, vomiting, anorexia, and weight loss resulting from obstruction or a malabsorption type syndrome caused by the multiple intestinal fistulas or intraluminal bacterial overgrowth1. Early recognition of this entity will ensure prompt institution of appropriate treatment, reducing morbidity and mortality in such patients [3].

Gossypiboma [4-7] is a mass lesion due to a retained surgical sponge surrounded by foreign-body reaction. It can cause serious morbidity and even mortality. Because it is not anticipated, it is frequently misdiagnosed, and often unnecessary radical surgical procedures are performed. ‘Doctor liable for damages where foreign object left in body after surgery - In a case of medical negligence where a surgeon performed explorative laparotomy and left a surgical mop (gossypiboma) in the body that resulted in complications necessitating a second surgery, the National Commission held that this constituted medical negligence. The complainant was awarded `3.5 lakhs as compensation for medical expenditure, mental agony and trauma’ [8,9].

Case Description

Since January 2009, we have dealt with a total number of 37 cases in Khulna Medical College Hospital (KMCH), Bangladesh. In most of the cases, operations were done in outside private clinics. Among those patients, some common key findings have been observed.

Common findings

1. Mostly the ultimate fate of retained mop following abdominal surgery is as follows (Flow chart 1).