-
BMJ Case Reports Sep 2018A gossypiboma is a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma...
A gossypiboma is a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. We describe an unusual presentation of a gossypiboma presenting in a 32-year-old man with acute epigastric pain and haematemesis. His surgical history revealed an emergency laparotomy following a road traffic accident 16 years ago. Initial gastroscopy showed extrinsic stomach compression. An abdominal ultrasound scan followed by a CT scan evidenced a large, well-defined, predominantly cystic mass with some solid areas occupying the left hypochondrium. Conservative management with insertion of a percutaneous drain proved to be inefficient. A laparotomy was performed; intraoperatively, the cyst was found to be ruptured and within it, a large surgical gauze was found. This was removed but required a distal pancreatectomy and gastrectomy for complete excision. He was discharged on day 74 of admission with outpatient follow-up.
Topics: Abdomen; Abdominal Pain; Adult; Diagnosis, Differential; Foreign Bodies; Humans; Male; Surgical Sponges; Tomography, X-Ray Computed
PubMed: 30257871
DOI: 10.1136/bcr-2017-221537 -
Nature Communications Aug 2021Developing an anti-infective shape-memory hemostatic sponge able to guide in situ tissue regeneration for noncompressible hemorrhages in civilian and battlefield...
Developing an anti-infective shape-memory hemostatic sponge able to guide in situ tissue regeneration for noncompressible hemorrhages in civilian and battlefield settings remains a challenge. Here we engineer hemostatic chitosan sponges with highly interconnective microchannels by combining 3D printed microfiber leaching, freeze-drying, and superficial active modification. We demonstrate that the microchannelled alkylated chitosan sponge (MACS) exhibits the capacity for water and blood absorption, as well as rapid shape recovery. We show that compared to clinically used gauze, gelatin sponge, CELOX™, and CELOX™-gauze, the MACS provides higher pro-coagulant and hemostatic capacities in lethally normal and heparinized rat and pig liver perforation wound models. We demonstrate its anti-infective activity against S. aureus and E. coli and its promotion of liver parenchymal cell infiltration, vascularization, and tissue integration in a rat liver defect model. Overall, the MACS demonstrates promising clinical translational potential in treating lethal noncompressible hemorrhage and facilitating wound healing.
Topics: Alkylation; Animals; Bacterial Infections; Blood Coagulation; Chitosan; Hemorrhage; Hemostatic Techniques; Liver; Liver Diseases; Liver Regeneration; Male; Materials Testing; Microscopy, Electron, Scanning; Porosity; Rats; Surgical Sponges; Swine; Swine, Miniature; Wound Healing
PubMed: 34354068
DOI: 10.1038/s41467-021-24972-2 -
ANZ Journal of Surgery Oct 2021An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in... (Review)
Review
BACKGROUND
An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in the literature of intraoperative anaphylaxis secondary to locally applied haemostatic agents.
METHODS
An electronic search was performed on databases Medline, Embase, Pubmed and ProQuest. A total of 7671 articles were reviewed from title and abstract. After exclusion criteria and duplicates removed, 19 articles with 21 cases were included for analysis. Data extracted from each of the articles included patient demographics, haemostatic agent used, surgery type, known allergies and any objective evidence of hypersensitivity post anaphylactic episode, that is tryptase levels, IgE levels, skin prick testing.
RESULTS
Fifty-seven percent of cases involved patients <18 years of age; 57% of cases involved spinal surgery; 100% of cases displayed objective evidence of hypersensitivity (tryptase levels, bovine or porcine IgE levels, or skin prick testing). Thirty-three percent of patients had exposure preoperatively to a known agent causing anaphylaxis or allergy which would preclude the use of a gelatin-based haemostat. These products included vaccines, spam meats, red meat, Jell-O and CollaPlug. Gelatin-based haemostat agents included Floseal, Gelfoam, Surgiflo, fibrin glue, Avitene, haemofibrine sponge, topical bovine thrombin and thrombin-soaked gelatin.
CONCLUSION
Increased awareness of allergy to gelatin-based haemostats for surgical and anaesthetic is imperative, with 33% of cases having a known contraindication to gelatin-based haemostat. This review highlights important aspects in the pre-operative patient history and post-event patient investigation that could assist anaesthetists and surgeons in the prevention of future events.
Topics: Anaphylaxis; Animals; Cattle; Collagen; Gelatin; Gelatin Sponge, Absorbable; Hemostatics; Humans; Swine
PubMed: 33682323
DOI: 10.1111/ans.16716 -
Legal Medicine (Tokyo, Japan) Mar 2018Retained surgical sponge events continue to occur despite the implementation of preventive surgical count policies, procedures, and adjunct technologies to manual...
Retained surgical sponge events continue to occur despite the implementation of preventive surgical count policies, procedures, and adjunct technologies to manual counting. Such intraoperative mistakes can cause chronic nonspecific symptoms during the early postoperative period. When discovered years after surgery, they raise thorny medicolegal questions. We describe two cases from our practice that illustrate the need to identify the responsibility of the surgical team, as delineated in ministerial directives and the current legal framework, as well as the difficulty in evaluating clinical actions taken at different times and in different settings, with regard to the permanent health damage incurred by sponge retention. Finally, we discuss prevention actions operating room staff should take to reduce the risk of retained surgical sponges.
Topics: Female; Foreign Bodies; Humans; Liability, Legal; Medical Errors; Middle Aged; Operating Room Technicians; Postoperative Complications
PubMed: 29413994
DOI: 10.1016/j.legalmed.2018.01.003 -
Surgical Innovation Dec 2020Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using...
Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.
Topics: Foreign Bodies; Humans; Surgical Sponges
PubMed: 32723214
DOI: 10.1177/1553350620943349 -
International Journal of Computer... Aug 2023Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and...
PURPOSE
Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and surgical sponge, the association of the retained surgical item detectability with human visual evaluation has not been sufficiently examined. In this study, we investigated the association of retained surgical item detectability between deep learning and human subjective evaluation.
METHODS
A deep learning model was constructed from 2987 training images and 1298 validation images, which were obtained from post-processing of the image fusion between X-ray images of normal post-operative radiography and surgical sponge. Then, another 800 images were used, i.e., 400 with and 400 without surgical sponge. The detection characteristics of retained sponges between the model and a general observer with 10-year clinical experience were analyzed using the receiver operator characteristics.
RESULTS
The following values from the deep learning model and observer were, respectively, derived: Cutoff values of probability were 0.37 and 0.45; areas under the curves were 0.87 and 0.76; sensitivity values were 85% and 61%; and specificity values were 73% and 92%.
CONCLUSION
For the detection of surgical sponges, we concluded that the deep learning model has higher sensitivity, while the human observer has higher specificity. These characteristics indicate that the deep learning system that is complementary to humans could support the clinical workflow in operation rooms for prevention of retained surgical items.
Topics: Humans; Deep Learning; X-Rays; Radiography; Foreign Bodies
PubMed: 36583837
DOI: 10.1007/s11548-022-02816-8 -
International Journal of Surgery Case... Feb 2022Gossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe...
INTRODUCTION AND IMPORTANCE
Gossypiboma is defined as developing an exudative inflammatory process around retained foreign bodies (RFBs). This problem may be asymptomatic or present with severe systemic or regional symptoms. Traditionally, every RFB must be removed with a surgical procedure. In the era of minimally invasive surgery, laparoscopic removal is a good choice for these problems.
CASE PRESENTATION
A young woman was referred to us with intermittent vague abdominal pain and a history of open cholecystectomy. After initial imaging, we found a twisted string-like object in epigastrium. Considering clinical findings and imaging, the patient was taken to the operating room with a diagnosis of RFB. After an explorative laparoscopy, we found an encapsulated fibrotic mass around a surgical sponge with pus-like secretions.
CONCLUSION
After diagnosing either RFB or gossypiboma, surgical intervention is mandatory, even in asymptomatic patients. Laparoscopy can help the surgeon to remove the retained item safely. Also, decreased length of stay and postoperative pain are significant advantages of laparoscopic removal.
PubMed: 35093706
DOI: 10.1016/j.ijscr.2022.106799 -
International Journal of Surgery Case... Aug 2022Textilloma or Gossypiboma refers as surgical sponges left behind in the surgical field during surgery. Although rare, occur commonly in practice and such cases are...
INTRODUCTION AND IMPORTANCE
Textilloma or Gossypiboma refers as surgical sponges left behind in the surgical field during surgery. Although rare, occur commonly in practice and such cases are rarely encountered in the literature due to their under-reporting. A retained surgical sponge is an avoidable surgical complication that can lead to patient morbidity, mortality and profound medico-legal implications.
CASE PRESENTATION
We report a case of intra-abdominal textiloma discovered early in a 31-year-old woman who underwent cesarean section due to placenta previa.
DISCUSSION
This complication in our surgical practice is still relevant despite the popularization of the World Health Organization checklist.
CONCLUSION
The purpose of reporting this case is to awaken practitioners to be more vigilant and avoid such circumstances.
PubMed: 35914478
DOI: 10.1016/j.ijscr.2022.107439 -
Contact Dermatitis Aug 2019
Topics: Adult; Dermatitis, Allergic Contact; Dermatitis, Occupational; Gloves, Surgical; Guanidines; Hand Dermatoses; Hand Disinfection; Humans; Male; Odorants; Surgeons; Surgical Sponges
PubMed: 30891773
DOI: 10.1111/cod.13270 -
International Journal of Biological... Dec 2020Silk fibroin (SF) is derived from Bombyx mori silkworm cocoons and has been used in textiles and as a suture material for decades. More recently, SF has been used for... (Comparative Study)
Comparative Study Review
Silk fibroin (SF) is derived from Bombyx mori silkworm cocoons and has been used in textiles and as a suture material for decades. More recently, SF has been used for various new biomedical applications, including as a wound dressing, owing to its excellent biological and mechanical properties. Specifically, the mechanical stiffness, versatility, biocompatibility, biodegradability, water vapour permeability and slight bactericidal properties make SF an excellent candidate biomaterial for wound dressing applications. The effectiveness of SF as a wound dressing has been tested and well-documented in vitro as well as in-vivo, as described here. Dressings based on SF are currently used for treating a wide variety of chronic and acute (e.g. burn) wounds. SF and its derivatives prepared as biomaterials are available as sponges, hydrogels, nanofibrous matrices, scaffolds, micro/nanoparticles, and films. The present review discusses the potential role of SF in wound dressing and its modulation for wound dressing applications. The comparison of SF based dressings with other natural polymers understands the readers, the scope and limitation of the subject in-depth.
Topics: Animals; Bandages; Bandages, Hydrocolloid; Biocompatible Materials; Biopolymers; Chemical Phenomena; Fibroins; Humans; Hydrogels; Manufactured Materials; Materials Testing; Nanostructures; Polyvinyl Alcohol; Rats; Rats, Sprague-Dawley; Silk; Surgical Sponges; Wound Healing; Zinc Oxide
PubMed: 32814099
DOI: 10.1016/j.ijbiomac.2020.08.041