Search

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 Lome. 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.

Gossypiboma is a dreaded event in surgical expertise. We report a case of post hemithyroidectomy gossypiboma removed 4 years post primary surgery. Initially suspecting it to be a tubercular abscess and fistula, we surprisingly found a surgical gauze on neck exploration. To understand the magnitude of this problem we assembled data on reported gossypibomas post neck surgeries. A detailed search of literature revealed 16 publications (20 cases) with varied clinical picture and differentials. Our case is only the fourth published case wherein there is such a long-standing history and the first to assemble data and review literature on exclusive neck gossypibomas. Although, neck is regarded as a confined cavity with very few obvious crevices where foreign body can be left behind iatrogenically; still, gossypiboma needs to be kept as a differential, especially with a previous surgical history.

Key Clinical Message Even if gossypibomas are extremely rare in the Oro‐Maxillofacial region, they should be evoked in bizarre tumors when repeated histology tests are not contributive, especially in patients with a history of dento‐sinusal surgery. As it is recommended in general surgery, gauzes should be carefully counted when used in dentistry.

Background Different from rhinoliths, the paranasal gossypiboma is a foreign body, such as a surgical sponge, left in the nasal cavity. It is a rare, frequently misdiagnosed disease that has rarely been reported. We summarize its clinical characteristics, management, and possible risk factors. Methodology We reviewed medical records of confirmed paranasal gossypibomas at a tertiary medical center between 2005 and 2015. Clinical symptoms, age, sex, anatomic sites, endoscopic photography, computed tomography, intraoperative findings, and past medical history were reviewed. Results The study included 21 patients, each of whom had ultimately undergone two operations. Among them, 20 underwent endoscopic nasal surgery in primary hospitals, and 15 had been misdiagnosed during the second surgery. The average interval to discovery of a retained foreign body was 200 days. Predominant occurrence sites were the maxillary and ethmoid sinuses. Computed tomography showed paranasal gossypiboma as a heterogeneous cystic lesion with a thin calcified shell. Conclusions A history of endoscopic nasal surgery, especially performed at a primary hospital, is a warning sign for clinicians. Computed tomography can add to the warning by showing a heterogeneous cystic lesion with a thin calcified shell. Clinicians should be aware of these characteristics to avoid misdiagnosing paranasal gossypiboma.

na

Objective: The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system. Material and Methods: This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radioopaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated. Results: All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No accident was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radioopaque sponge and fluoroscopy were available in 9 (23%) centers in these cases. Conclusion: Gossypiboma can be prevented not only with surgeons’ care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.

A surprising number of foreign bodies may be inadvertently left in tissues after surgery, including suture material, needles, surgical instruments, starch powder from gloves, fragments of lint and gauze swabs. In particular, the problem of the retained gauze swab is well recognised in human surgery, perhaps not surprisingly as there are so many used in each procedure. The inflammatory reaction to a retained gauze swab is called gossypiboma — from the Latin word gossypium in reference to the cotton fibres of the swab and the Swahili word boma meaning ‘place of concealment’. Gossypibomas occur because there is a failure to account for all the swabs used during a surgical procedure. Depending on the proximity to vital structures and the degree of associated inflammation and infection, the consequences of a retained surgical swab can range from abscess or fistula formation to life-threatening septicaemia or tumour formation. The veterinary nurse assisting in theatre has a vital role to play in minimising the incidence of retained items via surgical counting, good trolley management and effective communication.

The purpose of this study was to evaluate the sequential MRI findings of intramuscular gossypiboma and to correlate them with the pathologic findings in rabbits.Sterile gauze was packed in the hamstring muscles of 12 rabbits, and sequential MR images were obtained 1, 2, and 4 weeks and 2, 6, and 12 months after gauze insertion. Two rabbits were sacrificed at each time point. Their pathologic findings were compared with the MRI findings on each date.At the acute stage, the gossypibomas appeared as areas of heterogeneous low signal intensity on T2-weighted MR images with inflammatory change around the gossypiboma. In the subacute stage, the gossypibomas appeared as areas of peripheral low and central high signal intensity with wavy stripes of low signal intensity on T2-weighted images. On contrast-enhanced fat-suppressed T1-weighted images, the peripheral enhancement of the masses advanced toward the center of the mass as the fibrocollagenization between the gauze bundles progressed centrally. In the chronic stage, on contrast-enhanced fat-suppressed T1-weighted images, central advancement of the peripheral enhancement occurred according to the maturation of the fibrocollagenization. Calcifications around individual gauze fibers were observed 6-12 months after gauze insertion.On sequential contrast-enhanced fat-suppressed T1-weighted images of rabbits, intramuscular gossypiboma exhibited a chronologic centripetal enhancement pattern for 1 year mainly owing to concentric progression of fibrocollagenization between gauze bundles toward the center of the mass.

Gossypiboma is a term utilized to describe a mass developed from a matrix of cotton fibers surrounded by inflammatory granulomatous reaction. Its incidence is estimated at 0.15% to 0.2% of laparotomies. A foreign body within the abdominal cavity may provide a niche for proliferation of microorganisms, acting as primary focus for development of an abscess and peritonitis. Several studies have demonstrated the relevance of clinical correlation with the findings of different imaging methods (conventional radiography, ultrasonography, computed tomography and magnetic resonance imaging) in the diagnosis of gossypibomas. The present pictorial essay is aimed at demonstrating a series of typical cases of abdominal gossypibomas and illustrating the several presentations of such mass, with emphasis on the findings at different imaging methods in order to familiarize radiologists with this entity and with the main differential diagnosis.

The educational objectives of this self-assessment module are for the participants to exercise, self-assess, and improve their understanding of the most important features of gossypibomas and the role of imaging in the diagnosis of these masses.

Objective Textiloma and gossypiboma are terms used to describe a mass of cotton matrix that is left behind in a body cavity during an operation. This is an uncommon surgical complication. Gossypibomas are most frequently discovered in the abdomen. Such foreign bodies can often mimic tumors or abscesses clinically or radiologically; however, they are rarely reported because of the medicolegal implications. The manifestations and complications of gossypibomas are so variable that diagnosis is difficult and patient morbidity is significant. Conclusion This article discusses the clinical manifestations, pathophysiologic aspects, and most important complications related to gossypibomas; presents the classic imaging features of gossypibomas using a multitechnique approach; and shows some of the typical and atypical sites of gossypibomas.

(2008). Preventing gossypibomas and other iatrogenic harm from ‘lost’ items during surgical procedures. Veterinary Nursing Journal: Vol. 23, No. 8, pp. 36-39.

Ameliyatlarda kullanilan gossipibom olarak bilinen ve ameliyat sonrasinda cikarilan sungerler, maksiller sinuste kesfedilen nadir gorulen yabanci cisimlerdir. Maksiller sinusteki yabanci cisim semptomlari tek taraf li mukopurulan burun akintisi, burunda kotu koku ve konjesyon gibi kronik sinuziti isaret eden en sik gorulen yakinmalar ile birlikte daha sonraki evrelerde ortaya cikar. Bu makalede bas agrisi haricinde baska bir semptomu olmayan 40 yil once birakilmis maksiller sinus gossipibomu olan 77 yasindaki erkek bir olgu sunuldu. Ameliyat oncesinde cekilen paranazal sinus bilgisayarli tomografide sinonazal tumorlerin ve enflamatuvar patolojilerin ayirici tanisi goruldu. Bu olgu sunumunda maksiller sinusun yabanci cisimleri tartisildi. Anahtar Sozcukler: Yabanci cisimler; gossipibom; paranazal sinus tumorleri; paranazal sinusler. Postoperatively retained sponges used in operations, referred to as gossypibomas are rare foreign bodies discovered in the maxillary sinus. The symptoms of foreign bodies in the maxillary sinus appear at later stages with the most frequent complaints, indicating chronic sinusitis such as unilateral mucopurulent nasal discharge, nasal odor and congestion. In this article, we presented a 77-year-old male case of maxillary sinus gossypiboma which was left there 40 years ago, without any symptoms except headache. Preoperative paranasal sinus computed tomography suggested the differential diagnosis of sinonasal tumors, and inf lammatory pathologies. In this case report, foreign bodies of the maxillary sinus were discussed.

Background Surgical site infections following spinal surgery, including spinal abscesses, are rare but serious as they are major causes of morbidity, and even mortality. They are, however, rarely attributed to infected, retained surgical cottonoids or sponges (textiloma or gossypiboma) inadvertently left in an operative field. Case description A 53-year-old female with a history of two prior spinal operations at the L4-S1 levels (11 and 2 years previously) presented over a few weeks with the acute onset of a cauda equina syndrome (e.g., paraparesis and acute urinary incontinence). The patient demonstrated a mildly elevated white blood cell count (12,600/mm3) and abnormally increased C-reactive protein level that correlated with the magnetic resonance imaging that showed a dorsal epidural abscess extending from the L4 to S1 levels. At surgery, an encapsulated posterior epidural abscess was drained. Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid and was removed from the antero-inferior portion of the abscess wall at S1. Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca. After 2 months of ciprofloxacin, the patient's infection cleared but the motor deficit only partially resolved. Conclusion Most spinal textilomas (gossypibomas) are aseptic and are found in paraspinal areas without neurological symptoms or sequelae. These lesions may remain silent for years and may only rarely cause neurologic or infectious symptoms/signs. Notably, textilomas following spinal surgery may be largely avoided if proper cottonoid and sponge counts are done prior to closing spinal wounds.

We present the chest radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) findings of three pericardial gossypibomas, which are rarely reported and an exceptional complication of cardiovascular surgery. The diagnosis is usually possible with surgical history, high clinical suspicion, and awareness of variable imaging findings. Usage of sponges with radiopaque markers facilitates early detection by chest radiographs and CT. In case of radiolucent gossypibomas, specific MRI features help to differentiate this pathology from other masses and diffusion-weighted images can be used to distinguish it from an abscess.

In the era of advanced imaging triphasic CT is considered the most sensitive and specific investigative modality to qualify renal masses as renal cell carcinoma. Although the sensitivity and specificity for CT are 98 and 99%, respectively but it can still misdiagnose other pathologies as tumor.

Gossypiboma is used to describe a retained surgical swab in the body after an operation. Intraabdominal surgical sponge is an uncommon surgical error. Gossypiboma may cause serious morbidity and may lead to mortality. Gossypibomas should be included in the differential diagnosis of soft-tissue masses detected in patients with a history of a prior operation. In this case we present a 67-year-old female who had a laparotomy for acute cholecistecytitis 5 years previously and was discovered to have a retained surgical swab.

An intrathoracic gossypiboma is a rare condition. Moreover, intrathoracic gossypibomas with intrapulmonary location are extremely rare and only a few cases of intrapulmonary gossypiboma have been published. Usually gossypiboma has the characteristic CT appearance of a soft tissue mass with high attenuation, air bubbles and a whirl-like pattern, but its radiological manifestations may be variable according to the location and chronicity of the sponge. We report a case of intrathoracic gossypiboma initially misdiagnosed as an aspergilloma owing to its intrapulmonary location and air crescent sign on CT. In addition, our case will show morphological changes of the gossypiboma on CT during the 10 year follow-up period and correlate the CT findings with pathological results.

The plain-film, ultrasonography and computed tomography findings of retained surgical sponges (gossypibomas) are described in three patients. When a mass with hyperechoic wavy structures and posterior acoustic shadowing is seen on ultrasonography, the history of previous surgery must be questioned. Gossypiboma should be included in the differential diagnosis of such cases with a previous surgery. Plain film and computed tomography examinations should be obtained for correct pre-operative diagnosis.

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.

Purpose of Review: Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature. Materials and Methods: A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India. Results: On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1 st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%). Conclusions: Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.

Gossypibomas are foreign objects, usually surgical sponges or towels, accidentally retained in the human body during an operation. They are associated with significant postsurgical complications, morbidity and mortality. Postsurgical radiographs are considered the standard of care for a retained foreign body, but their detection sensitivity typically ranges between 60% and 80%. To address this we have microfabricated x-ray visible microtags that can be attached to foreign bodies and allow them to be easily recognized by a trained radiologist or a computer aided detection (CAD) algorithm. Key element of the microtag design is the use of three radiopaque beads placed in a precise, triangular configuration. We demonstrated that those microtags are visible in standard radiographs over different backgrounds (soft tissue, bone) and at different spatial orientations. We envision that these microtags attached to surgical sponges and towels will greatly increase the detection sensitivity and specificity of gossypibomas at an infinitesimal cost and will be used in the operating room to provide point of care information to the surgeons.

Laparoscopic removal of retained abdominal foreign bodies represents an obscure domain of minimally invasive surgery. Although not an infrequent situation in general surgical practice, there are very few papers presenting laparoscopic approache in these circumstances. An iatrogenic foreign body following surgery, is a serious complication that may lead to medico-legal problem. We present our experience and a literature review.In the last 20 years 48 patients with abdominal foreign bodies were referred to us. Out of these four gossypibomas were managed laparoscopically.Retained swabs represent the most common iatrogenic abdominal foreign bodies. Removal of gossypiboma present more problems in laparoscopic environment due to encapsulation and difficulties in localisation, as retained swabs unusually display radio-opaque markings. There was one conversion due to dense adhesion to the gastric wall. Postoperative recovery was uneventful in all cases.Gossypibomas, among abdominal foreign bodies, represent a certain reality with significant legal implications. Prevention should prevail and all efforts should be made in such respect. Laparoscopic approach is possible in selected cases (small swabs, encapsulated, no complications).

Background Intravesical retained surgical sponges are very rare and only a few cases have been removed by minimally invasive techniques. Case presentation We report a case of an intravesical gossypiboma in a 71-year-old man from western Nepal, who presented with urinary retention and persistent lower urinary tract symptoms one year after open cystolithotomy. He was diagnosed with an intravesical mass using ultrasonography. The retained surgical sponge was found during cystoscopy and removed through endoscopy. Conclusion Intravesical gossypibomas are rare and can mimic a bladder mass. This is one of the few reported cases of cystoscopic removal.

ossypibomas, or "textilomas," are retained surgical sponges or swabs that are uncommon complications of any surgical procedure. Gossypiboma is derived from Latin (gossypium, cotton) and Swahili (boma, place of concealment). Most cases have been reported in the abdomen or pelvis, and fewer intrathoracic parenchymal and pleural gossypibomas have been described-7 To our knowledge, only 1 case of a chest wall gossypiboma has been previously discussed, 3 and we present the findings of an additional case in a young female patient.

Resumen Los terminos gossypiboma, textiloma o cuerpo extrano textil retenido son terminos medicos usados para describir elementos quirurgicos textiles que intencional o accidentalmente son dejados sobre el lecho quirurgico, generando una reaccion a cuerpo extrano. Es una patologia prevenible siempre y cuando se tomen algunas medidas durante la cirugia. Los gossypiboma son poco frecuentes a nivel del sistema nervioso central. Son mas frecuentes en las cirugias toracicas o abdominales. Dependiendo de su localizacion y su comportamiento, estos pueden presentar complicaciones y sintomatologia o pueden permanecer silentes por muchos anos. En este trabajo se presenta un caso de un gossypiboma paraespinal asintomatico en una paciente operada 15 anos antes para una discectomia lumbar. Se hace ademas una revision de la literatura y se comenta acerca de la implicacion de estas lesiones en neurocirugia.

Here, we present chest radiography and computed tomography (CT) findings for three cases of mediastinal and pleural gossypiboma. Radiological manifestations varied according to the locations and chronicities of the gauze sponges and the types of reactions that they caused. CT analysis readily diagnosed gossypibomas in the early postoperative period by showing well-defined mediastinal- or pleural-based masses with hyperdense rims and central air bubbles. However, one patient presented in the late postoperative period, and a CT scan revealed a well-defined, solid pleural mass that was devoid of air bubbles; a correct diagnosis could not be established and the patient had to be reoperated on. Radiologists should be aware of different manifestations of this rare condition in cases of prior thoracic surgery and persistent respiratory symptoms.

Gossypiboma is composed of non-absorbable surgical material with a cotton matrix. Gossypiboma is usually under-reported and is a severe medicolegal issue. Thus, we describe the computed tomography (CT) findings of gossypiboma in our institution. From January 2003 to June 2006, gossypibomas diagnosed in our institution and their data regarding sex, age, previous operation, location, the interval between the operation and the diagnosis of gossypiboma, clinical presentation, indication of CT, CT findings and further management were collected. There were 6 cases of gossypiboma, 4 men and 2 women. Three of our cases had previous chest surgery and the other 3 cases had previous abdominal surgery. The locations of 3 (50%) cases were in the left anterior subphrenic space. The mean interval between original operation and diagnosis was 24.6 +/- 33.4 months (range, 17 days to 8 years). With regard to CT findings, 3 (50%) cases had an isodense mass and 3 (50%) had a typical mass containing curvilinear opaque structures. The mean size of the gossypibomas was 62 x 62 x 67 mm. Because gossypiboma is due solely to human factors and is a severe medicolegal issue, continuous education should be considered.

The CT findings in three cases of abdominal gossypibomas are presented, two of which mimic solid tumours. CT is suggested as a useful diagnostic method in the evaluation of masses suspected of being gossypibomas, especially when the characteristic whirl-like spongiform pattern and opaque markers are absent on plain film.

A retained surgical swab (gossypiboma) is a rare but important complication of intrathoracic surgery. The radiographic and computed tomography (CT) appearances are variable and depend on the chronicity and site of the swab within the chest. Two cases of retained swabs within the chest are reported. In both cases, the swab had become surrounded by lung. The swab within the pleural space acted as a nidus and resulted in infolding of the lung, superficially resembling an intrapulmonary abscess on CT.

A 51-year-old Korean woman with a history of breast cancer underwent screening bone scintigraphy, which revealed minimal soft tissue uptake of Tc-99m methylene diphosphonate (MDP) in the right lower quadrant. CT and plain films confirmed that the uptake was due to a retained surgical sponge or gossypiboma. The incidence of gossypibomas has been reported at high as 1 in 1000 to 15,000 intra-abdominal operations. The natural progression of an aseptic gossypiboma is a foreign body reaction and granuloma formation. This inflammatory granulomatous reaction is the most likely cause of the extraosseous accumulation of Tc-99m MDP. This entity should be added to the already extensive list of etiologies of extraosseous MDP accumulation.

An unusual case of gossypiboma, a foreign cotton body, in a 75-year-old male patient, who underwent staging studies for colon adenocarcinoma, is presented. A lower pole mass on his right kidney appeared on the preoperative workup, which was revealed to be a retained gauze, during the surgical exploration. A history of renal stone surgery, 32 years before was the possible reason of this situation. There are relatively few reports in the literature concerning gossypibomas, however, their true incidence might be underestimated due to underreporting because of legal implications.

An uncommon complication of any surgery is iatrogenic retained foreign body. This condition is gossypibomas. In this case report, we present cases of middle-aged females who had undergone total abdominal hysterectomy and came to us with feature of intestinal obstruction. She was diagnosed radiologically, and later a review surgery was performed. A prompt diagnosis and treatment is necessary to reduce morbidity and mortality of this condition. It is to emphasize that any post-operative patient who present to us with complaints of pain or obstruction, the differential diagnosis must include retained foreign body (gossypibomas).

Gossypibomas, masses of retained cotton materials, may produce a variety of postoperative complications. This case report of hemoptysis of 18 months' duration and cavitating chest masses in a 62-year-old man with previous cardiac operations illustrates several salient features about the presentation, differential diagnosis, and management of gossypibomas.

We herein report a gossypiboma resulting from a retained surgical swab, which had been left in peritoneum for 20 years 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.

The CT and ultrasound features of retained sponges (gossypibomas) are described in six patients. They are well-circumscribed cystic masses without surrounding edema. The retained sponges or towels were correctly identified in only three cases. In the other three cases retained sponges were organized and lost their original configuration. Gas was seen in one case and calcification in two cases. Gossypibomas should be included in the differential diagnosis in all patients with a well-circumscribed cystic mass in the abdomen and with a history of previous laparotomy.