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The Veterinary Record Oct 2011
Topics: Animals; Dog Diseases; Female; Foreign Bodies; Male; Postoperative Complications; Surgical Sponges
PubMed: 22021269
DOI: 10.1136/vr.d6807 -
Improving safety in the operating room: a systematic literature review of retained surgical sponges.Current Opinion in Anaesthesiology Apr 2009Gossypibomas are surgical sponges that are unintentionally left inside a patient during a surgical procedure. To improve this patient safety indicator, anesthesiologists... (Review)
Review
PURPOSE OF REVIEW
Gossypibomas are surgical sponges that are unintentionally left inside a patient during a surgical procedure. To improve this patient safety indicator, anesthesiologists will need to work with operating room personnel. This study's goal was to systematically review the literature on retained sponges to identify body location, time to discovery, methods for detection, and risk factors.
RECENT FINDINGS
Two hundred and fifty-four gossypiboma cases (147 reports from the period 1963-2008) were identified via the National Library of Medicine's Medline and the Cochrane Library. Gossypibomas (mean patient age 49 years, range 6-92 years) were most commonly found in the abdomen (56%), pelvis (18%), and thorax (11%). Average discovery time equaled 6.9 years (SD 10.2 years) with a median (quartiles) of 2.2 years (0.3-8.4 years). The most common detection methods were computed tomography (61%), radiography (35%), and ultrasound (34%). Pain/irritation (42%), palpable mass (27%), and fever (12%) were the leading signs and symptoms, but 6% of cases were asymptomatic. Complications included adhesion (31%), abscess (24%), and fistula (20%). Risk factors were case specific (e.g. emergency) or related to the surgical environment (e.g. poor communication). Most gossypibomas occurred when the sponge count was falsely pronounced correct at the end of surgery.
SUMMARY
More is being discovered about the patterns leading to a retained sponge. Multidisciplinary approaches and new technologies may help reduce this low frequency but clinically significant event. However, given the complexity of surgical care, eliminating retained sponges may prove elusive.
Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Foreign Bodies; Humans; Incidence; Male; Middle Aged; Pelvis; Radiography; Risk Factors; Surgical Sponges; Ultrasonography; Young Adult
PubMed: 19390247
DOI: 10.1097/ACO.0b013e328324f82d -
The Veterinary Record Sep 2011To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats...
To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats that were referred to four referral centres were reviewed. Cases in which a retained surgical swab was identified during surgery at the referral hospital were selected for further study. The signalment, history, clinical signs, diagnostic and surgical findings and outcome in these cases were reviewed. Thirteen dogs with retained surgical swabs were included in the study. Bodyweight ranged from 9 to 45 kg. The initial surgery was a 'non-routine' abdominal procedure in seven dogs, ovariohysterectomy in five dogs and perineal hernia repair in one dog. Time from initial surgery to presentation at the referral centre ranged from four days to seven years. Treatment involved major surgery in eight of the 13 dogs. Outcome was excellent in 12 of 13 cases, one dog was euthanased.
Topics: Animals; Dog Diseases; Dogs; Female; Foreign Bodies; Male; Postoperative Complications; Reoperation; Risk Factors; Surgical Sponges
PubMed: 21846684
DOI: 10.1136/vr.d4396 -
Obstetrical & Gynecological Survey Jul 2008Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports... (Review)
Review
Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports a case in which a retained surgical sponge eroded from the intra-abdominal space into the intestinal lumen, migrated distally, and spontaneously passed with defecation 12 weeks after the cesarean section. We performed a systematic review of the literature in Pubmed and found 64 cases of transmural migration of retained surgical sponges. Sixty-four cases have been reported of transmural migration, mainly after intra-abdominal surgery. The most frequent site of impaction is the intestine (75%), but we also found 2 cases that describe migration into the stomach and 7 into the bladder. Five more cases have been published describing transdiaphragmic migration. Only 4 cases describe a sponge spontaneously expelled through the rectum, whereas more than 93% needed re-intervention. We strongly advise only the use sponges with radiopaque markers during surgery and additional methodical wound/body cavity examination.
Topics: Adult; Anemia; Cesarean Section; Diarrhea; Female; Foreign-Body Migration; Hemostatics; Humans; Surgical Sponges
PubMed: 18559122
DOI: 10.1097/OGX.0b013e318173538e -
The American Journal of Case Reports Sep 2020BACKGROUND During any surgical procedure, there are several factors that may lead to morbidity and mortality. One of those factors is a retained cotton or gauze surgical...
BACKGROUND During any surgical procedure, there are several factors that may lead to morbidity and mortality. One of those factors is a retained cotton or gauze surgical sponge inadvertently left in the body during an operation, known as gossypiboma. This clinical oversight may cause serious postoperative complications and increase the risk of mortality, particularly if left undiscovered. Furthermore, this issue adds to the economic burden on healthcare systems by increasing the rate of reoperation and rehospitalization. The length of postoperative gossypiboma diagnosis varies greatly, as patients may either present acutely with symptoms such as a palpable mass, pain, nausea, and vomiting, or remain asymptomatic for several years. CASE REPORT We report the case of a 48-year-old man who underwent a thoracotomy after a road traffic accident. The resulting empyema led to the intraoperative discovery of an intrathoracic gossypiboma, which was initially interpreted radiologically as a part of the previous surgical staple line. The causative agent was discovered by the team's nurses during the postsurgical count of instruments and sponges, and who were alerted to a recovered sponge differing in appearance from the sponges used for that procedure. CONCLUSIONS In general, proper counting and adherence to the World Health Organization 'Surgical Safety Checklist' can greatly improve the outcome of any surgery. The diagnosis of gossypiboma is often late or missed entirely and leads to additional interventions that can be avoided or detected early when the material contains a radiopaque marker. In cases under suspicion of any mistakenly left object, the use of intraoperative radiology before skin closure is highly recommended to prevent postoperative complications for the patient and organization.
Topics: Foreign Bodies; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Surgical Sponges; Thoracotomy
PubMed: 32893262
DOI: 10.12659/AJCR.923992 -
World Journal of Gastroenterology Mar 2016Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal...
Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications.
Topics: Adult; Colon, Sigmoid; Colonoscopy; Device Removal; Female; Foreign Bodies; Humans; Hysterectomy; Intestinal Perforation; Rectum; Reoperation; Surgical Sponges; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26973401
DOI: 10.3748/wjg.v22.i10.3052 -
The Iowa Orthopaedic Journal 2017While the true incidence of retained foreign bodies after surgery is unknown, it has been approximated at 1:5,500 operations overall, with substantially less frequency...
BACKGROUND
While the true incidence of retained foreign bodies after surgery is unknown, it has been approximated at 1:5,500 operations overall, with substantially less frequency in hand and upper extremity procedures. Despite the rarity of foreign body retention in hand and upper extremity surgery, universal radiofrequency scanning for electronically-tagged sponges and automatic radiographic evaluation for incorrect sponge counts are employed for all surgical procedures at our institution. We demonstrate the infeasibility of retaining an operative sponge of a standard size in commonly performed hand and upper extremity procedures with incision sizes of two centimeters or less, and establish that visual detection of sponges in these cases is adequate.
METHODS
Eighteen trigger finger releases, five carpal tunnel releases, three trigger thumb releases, and three de Quervain's tenosynovitis releases were successfully performed upon five cadaveric specimens by residents under supervision of fellowship-trained hand surgeons for a total of 29 two-centimeter or smaller incisions. Randomized surgical sponge placement was evaluated by a blinded observer at two distances and incision sizes were quantified. Kappa values were calculated to determine the acuity of visual detection versus the actual presence of a sponge.
RESULTS
The maximum length of the standard surgical sponge that could be contained within an incision was three centimeters. When compared with the gold standard (whether the sponge had been placed or not by the operating resident), the placement of a standard surgical sponge could be detected correctly in 100% of cases at both "across the room" and "at the table" distances, for kappa values of 1.0 and 1.0 respectively. This did not vary with incision size or surgical procedure.
CONCLUSIONS
The added cost and time from radiofrequency detection of retained sponges and radiographic evaluation in the event of incorrect sponge counts can be safely eliminated if sponges can be reliably visually detected.
CLINICAL RELEVANCE
This cadaveric study informs patient safety practices by demonstrating that visual detection of surgical sponges is adequate for certain upper extremity procedures.
Topics: Foreign Bodies; Humans; Orthopedic Procedures; Surgical Sponges; Upper Extremity
PubMed: 28852356
DOI: No ID Found -
Transmural migration of a retained surgical sponge into the intestinal lumen: an experimental study.Journal of the Medical Association of... Jul 1996A retained surgical sponge in the peritoneal cavity is an occasional misadventure in modern surgery. Such a sponge can migrate into the intestinal lumen, but its...
A retained surgical sponge in the peritoneal cavity is an occasional misadventure in modern surgery. Such a sponge can migrate into the intestinal lumen, but its mechanism is still unknown. A piece of surgical sponge, measuring 4 x 4 centrimetres, was placed at different sites of the abdominal cavity of Wistar rats. Inspite of the absence of infection, entry of the sponge into the intestinal lumen was shown microscopically in 10 out of 36 rats. Parallel statistical analysis by Cutler-Ederer estimation was found to be 0.58 of condition probability at 6 months. Transmural migration of a retained surgical sponge was not only associated with different sites placing in the abdominal cavity (P = 0.680), but also whether a seromuscular incision was made or not (P = 0.306). A hypothesis, based on a study of microscopic and macroscopic pathology, is proposed as four stages: foreign body reaction, secondary infection, mass formation and remodeling.
Topics: Animals; Chi-Square Distribution; Foreign-Body Migration; Granuloma, Foreign-Body; Intestines; Male; Peritoneal Cavity; Probability; Rats; Rats, Wistar; Surgical Sponges
PubMed: 8855619
DOI: No ID Found -
AJR. American Journal of Roentgenology Sep 1993
Topics: Adult; Foreign Bodies; Foreign-Body Reaction; Humans; Male; Neck; Surgical Sponges; Thyroidectomy
PubMed: 8352128
DOI: 10.2214/ajr.161.3.8352128 -
JBR-BTR : Organe de La Societe Royale... 2010The inadvertent loss of surgical sponges remains a dreadful hazard of surgery. We report the case of a patient with a medical history of myotonic dystrophy type 1 who...
The inadvertent loss of surgical sponges remains a dreadful hazard of surgery. We report the case of a patient with a medical history of myotonic dystrophy type 1 who had received a right upper lobectomy for the treatment of a stage IIA (pT1N1M0) well differentiated neuroendocrine carcinoma. In the early postoperative period, aspiration of gastric contents occurred and the patient underwent endotracheal intubation and mechanical ventilation. A follow-up multi-detector computed tomography (MDCT) scan of the chest showed a complex mass in interlobar position with an internal radiopaque serpiginous thread of metallic density which was assumed to represent a retained surgical sponge. Upon surgical exploration, no retained foreign body was found and a zone of recent hemorrhagic infarction, bordered by the line of the mechanical staples used to complete the minor fissure, was removed from the middle lobe. When evaluating patients suspected of having a retained surgical sponge, thoracic surgeons and radiologists should be aware of this potential source of confusion.
Topics: Foreign Bodies; Humans; Male; Middle Aged; Postoperative Complications; Surgical Sponges; Surgical Stapling; Tomography, X-Ray Computed
PubMed: 21179987
DOI: 10.5334/jbr-btr.332