Keywords
inflammatory pseudotumour
foreign body reaction
How to Cite
Abstract
Background: Gossypiboma, the retention of a surgical sponge or gauze within a body cavity following an operative procedure, is a rare but clinically significant complication. It may manifest acutely or after a prolonged latent period, presenting diagnostic difficulties even with advanced imaging modalities.
Case Summary: We report the case of a 26-year-old woman who presented with a two-week history of abdominal pain and distension, eight months after an uneventful cesarean section. Abdominal computed tomography (CT) with contrast identified a peri-umbilical mass (92 × 69 mm) with heterogeneous density and characteristics compatible with gossypiboma. Laparotomy was undertaken on the basis of this radiological suspicion; however, no retained surgical material was found. Instead, the operative finding was an inflammatory pseudotumor of the greater omentum, confirmed histopathologically as a chronic fibro-inflammatory process. The patient made an uneventful recovery and was discharged on postoperative day three.
Conclusion: This case illustrates the considerable diagnostic overlap between gossypiboma and other intra-abdominal masses, particularly omental inflammatory pseudotumors. It underscores the critical need for interdisciplinary caution, rigorous intra-operative documentation, and strict surgical sponge-counting protocols to mitigate both clinical and medicolegal risks.
References
Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003;348(3):229–235.
Rappaport W, Haynes K. The retained surgical sponge following intra-abdominal surgery. A continuing problem. Arch Surg. 1990;125(3):405–407.
Lauwers PR, Van Hee RH. Intraperitoneal gossypibomas: the need to count sponges. World J Surg. 2000;24(5):521–527.
Cima RR, Kollengode A, Garnatz J, Storsveen A, Weisbrod C, Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg. 2008;207(1):80–87.
Lincourt AE, Harrell A, Cristiano J, Sechrist C, Kercher K, Heniford BT. Retained foreign bodies after surgery. J Surg Res. 2007;138(2):170–174.
Kaiser CW, Friedman S, Spurling KP, Slowick T, Kaiser HA. The retained surgical sponge. Ann Surg. 1996;224(1):79–84.
Wan W, Le T, Riskin L, Macario A. Improving safety in the operating room: a systematic literature review of retained surgical sponges. Curr Opin Anaesthesiol. 2009;22(2):207–214.
O'Connor AR, Coakley FV, Meng MV, Eberhardt S. Imaging of retained surgical sponges in the abdomen and pelvis. AJR Am J Roentgenol. 2003;180(2):481–489.
Patrzyk M, Glitsch A, Schreiber A, von Bernstorff W, Heidecke CD. Single-incision laparoscopic surgery as an approach for the surgical removal of an intra-abdominal gossypiboma: first description of the use of a single-incision laparoscopic approach. Langenbecks Arch Surg. 2010;395(4):445–447.
Lata I, Ahuja A, Sharma KA. Gossypiboma: a case report and review of literature. Int J Crit Illn Inj Sci. 2012;2(3):158–161.
Saxena AK, Bhatt S, Bhargava SK. Gossypiboma — a preventable problem! A case report and review of literature. Indian J Radiol Imaging. 2009;19(3):216–218.
Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J. Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol. 2009;193(6 Suppl):S94–S101.
Suwatanapongched T, Boonkasem S, Sathianpitayakul E, Leelachaikul P. Intrathoracic gossypiboma: radiographic and CT findings. Br J Radiol. 2005;78(934):851–853.
González-Ojeda A, Rodríguez-Alcántar DA, Arenas-Márquez H, et al. Retained foreign body following intra-abdominal surgery. Hepatogastroenterology. 1999;46(26):808–812.
Chau WK, Lai KH. Ultrasonographic evaluation of abdominal gossypiboma. J Clin Ultrasound. 1988;16(7):497–501.
Kopka L, Fischer U, Gross AJ, Funke M, Oestmann JW, Grabbe E. CT of retained surgical sponges (textilomas): pitfalls in detection and evaluation. J Comput Assist Tomogr. 1996;20(6):919–923.
Kalovidouris A, Kehagias D, Moulopoulos L, Gouliamos A, Pentea S, Vlahos L. Abdominal retained surgical sponge with a low signal intensity rim on MR images. Eur Radiol. 1999;9(7):1293–1296.
Tamijmarane A, Bhati CS, Mirza DF, Mayer DA, Buckels JA. Gossypiboma masquerading as a liver tumour. Ann R Coll Surg Engl. 2007;89(8):W6–8.
Mehtsun WT, Ibrahim AM, Diener-West M, Pronovost PJ, Makary MA. Surgical never events in the United States. Surgery. 2013;153(4):465–472.
Joint Commission on Accreditation of Healthcare Organizations. Preventing unintended retained foreign objects. Sentinel Event Alert. 2013;(51):1–5.
Stawicki SP, Evans DC, Cipolla J, et al. Retained surgical foreign bodies: a comprehensive review of risks and preventive strategies. Scand J Surg. 2009;98(1):8–17.
Arikanoglu Z, Aygen E, Camci C, et al. Gossypiboma: a single-center experience. Acta Chir Belg. 2011;111(4):232–235.
Zbar AP, Rahway NY. The radiology of gossypiboma. J Postgrad Med. 2008;54(3):234–237.
Topal U, Gebitekin C, Tuncel E. Intrapulmonary gossypiboma. AJR Am J Roentgenol. 2001;177(6):1485–1486.
Genc V, Sulaimanov M, Cipe G, et al. What necessitates the conversion to open surgery during laparoscopic cholecystectomy? Lessons learned from re-operations. Sci World J. 2012;2012:943564.
Gossios KJ, Tsianos EV, Demou LL, et al. Use of computed tomography after abdominal surgery. Eur Radiol. 1993;3:105–114.
Coffin CM, Watterson J, Priest JR, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor): a clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol. 1995;19(8):859–872.
Pungpapong S, Geiger XJ, Raimondo M. Inflammatory myofibroblastic tumor presenting as a pancreatic mass: a case report and review of the literature. JOP. 2004;5(5):360–367.
Kim SJ, Kim WS, Cheon JE, et al. Inflammatory pseudotumors of the abdomen and pelvis: making the imaging diagnosis. Korean J Radiol. 2009;10(1):83–93.
Yorimitsu M, Tamiya T, Yamamoto Y, Sato H. FDG-PET findings in a case of gossypiboma. Ann Nucl Med. 2004;18(1):85–88.
Ojili V, Bhargava M, Kumar N, Rozario N. Gossypiboma: MR imaging findings and review. Australas Radiol. 2007;51(Suppl):B267–270.
Karabay N, Sencan I, Karadeniz-Bilgili E, Ogut E, Kabas E. Retained surgical sponge: a review of cases and special emphasis on diagnosis and management. Surg Today. 2006;36(11):955–958.
Memon MA, Khan S, Yunus RM, Barr R, Memon B. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008;22(8):1781–1789.
National Health Service England. Never events list 2018. NHS Improvement; 2018.
Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns leading to injury in surgical patients. J Am Coll Surg. 2007;204(4):533–540.
Cima RR, Deschamps C, Cassivi SD, Kulaylat MN. Improving compliance with the Surgical Care Improvement Project measures. Am J Surg. 2009;198(6):821–826.
Macario A, Morris D, Morris S. Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology. Arch Surg. 2006;141(7):659–662.
Cima RR, Kollengode A, Clark J, et al. Using a data-matrix-coded sponge counting system across a surgical practice: impact after 18 months. Jt Comm J Qual Patient Saf. 2011;37(2):51–58.
Dogjani A, Haxhirexha K, Gjata A, Dhima A, Blloshmi A. Intrahepatic pseudoaneurysm of right hepatic artery after gunshot thoracic-abdominal injury: a case report and review of the literature. Arch Clin Med Case Rep. 2022;6:517-20. doi:10.26502/acmcr.96550506.
Sheth NP, DeAngelis JP, Wasielewski R, Ramsey ML, Glaser DL. Intraoperative use of RFID technology: assessment of safety and feasibility in a cadaveric model. J Orthop Surg Res. 2009;4:24.
Lingard L, Espin S, Whyte S, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care. 2004;13(5):330–334.