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International Journal of Surgery Case... 2020Retained surgical sponges and instruments is a well-recognized medical error that may occur after all kinds of surgeries. This event has a catastrophic impact on the...
INTRODUCTION
Retained surgical sponges and instruments is a well-recognized medical error that may occur after all kinds of surgeries. This event has a catastrophic impact on the patient, health care workers, and the health institution. Sometimes, it is termed as textiloma or gossypiboma.
CASE PRESENTATION
A 40-year-old lady presented with abdominal pain, diarrhea and bilious vomiting for 3 days. The patients had history of cesarean section which was performed before 4 months. During examination she was pale and she had tenderness in the lower abdomen. CT-scan of the abdomen showed thickening of the wall of the sigmoid colon with evidence of intramural air and dilated small bowel loops. Colonoscopy showed evidence of surgical sponge causing transmural erosion and ulceration of the sigmoid colon. During surgery there was an evidence of a retained surgical sponge resulting in fistula between the ileum and the sigmoid colon. Resection of the involved part of the ileum and the sigmoid colon was done with end-end anastomosis. After 10 days she developed complete abdominal dehiscence. An emergency operation was performed for the patient and the abdomen was closed with tension sutures.
CONCLUSION
The surgical team is responsible for preventing this event by careful inspection of the surgical site using all the available methods and technology. Technology increases the safety but doesn't accurately prevent the accidents. All causative human and technical factors must be addressed carefully.
PubMed: 32007866
DOI: 10.1016/j.ijscr.2020.01.018 -
Annals of Surgery Jul 1996A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges.
OBJECTIVE
A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges.
METHODS
Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period.
RESULTS
Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied.
CONCLUSIONS
Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures.
Topics: Abdomen; Costs and Cost Analysis; Female; Foreign Bodies; Humans; Insurance, Liability; Male; Malpractice; Massachusetts; Postoperative Complications; Surgical Sponges
PubMed: 8678622
DOI: 10.1097/00000658-199607000-00012 -
Ear, Nose, & Throat Journal Feb 2020
Topics: Diagnosis, Differential; Foreign Bodies; Humans; Kazakhstan; Male; Medical Illustration; Middle Aged; Postoperative Complications; Recurrent Laryngeal Nerve; Surgical Sponges
PubMed: 30955368
DOI: 10.1177/0145561319840512 -
Journal of Controlled Release :... Oct 2016Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material... (Review)
Review
Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.
Topics: Antineoplastic Agents; Chemoembolization, Therapeutic; Chitosan; Drug Carriers; Gelatin Sponge, Absorbable; Humans; Neovascularization, Pathologic; Polyethylene Glycols; Polymers; Vascular Malformations
PubMed: 26924353
DOI: 10.1016/j.jconrel.2016.02.033 -
Critical Care (London, England) Jul 2020Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings...
BACKGROUND
Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress.
METHODS
Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection.
RESULTS
A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28-2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34-3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60-0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51-5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38-2.71, p < 0.01).
CONCLUSIONS
We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis.
TRIALS REGISTRATION
These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235 ).
Topics: Adult; Animals; Bandages; Catheter-Related Infections; Catheterization, Central Venous; Catheterization, Peripheral; Chlorhexidine; Critical Illness; Disinfection; Female; Humans; Male; Middle Aged; Surgical Sponges; Time Factors
PubMed: 32703235
DOI: 10.1186/s13054-020-03174-0 -
Orthopaedic Surgery May 2021The aim of the present study was to use a gelatin sponge impregnated with dexamethasone, combined with minimally invasive transforaminal lumbar interbody fusion...
Safety and Efficacy of Minimally Invasive Transforaminal Lumbar Interbody Fusion Combined with Gelatin Sponge Impregnated with Dexamethasone and No Drainage Tube after Surgery in the Treatment of Lumbar Degenerative Disease.
OBJECTIVE
The aim of the present study was to use a gelatin sponge impregnated with dexamethasone, combined with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and no drainage tube after the operation for early postoperative recurrence of root pain caused by edema.
METHODS
A prospective case series study was designed. From September 2015 to January 2018, eligible patients diagnosed with lumbar degenerative disease underwent MIS-TLIF combined with a gelatin sponge impregnated with dexamethasone and no drainage tube after surgery. The short-term clinical data were collected, such as visual analog scale (VAS) scores for low back pain and leg pain preoperatively and on postoperative days (POD) 1-10, time bedridden postoperatively, and length of hospital stay postoperatively. Long-term indicators include the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) score, and the 36-Item Short-Form Health Survey (SF-36) score, evaluated preoperatively and 1 week, 3 months, and more than 1 year postoperatively.
RESULTS
Complete clinical data was obtained for 139 patients. All patients were followed up for more than 12 months (13.7 ± 3.3 months). The average bedridden period was 1.5 ± 0.4 days and hospital stays were 2.7 ± 0.9 days. The VAS score of leg and back pain on POD 1-10 were all decreased compared with preoperation (all P < 0.0001). At the last follow up, the VAS scores for back pain and leg pain (0.69 ± 0.47; 1.02 ± 0.55) and the ODI score (11.1 ± 3.5) decreased (all P < 0.0001), and the JOA score (27.1 ± 3.2) and the SF-36 (physical component summary, 50.5 ± 7.3; mental component summary, 49.4 ± 8.9) increased (all P < 0.0001) compared with preoperative values. Patients' early and long-term levels of satisfaction postoperatively were 92.8% and 97.8%, respectively. At POD 7 and the last follow-up, the improvement rate of the JOA score, respectively, was 41.8% ± 10.6% and 87.7% ± 8.2%, and clinical effects assessed as significantly effective according to the improvement rate of the JOA score was 16.5% and 66.9%, respectively. There were 2 (1.4%) cases with complications, including 1 (0.7%) case of wound infection and 1 (0.7%) case of deep vein thrombosis. There were no device-related complications or neurological injuries.
CONCLUSION
Use of a gelatin sponge impregnated with dexamethasone combined with MIS-TLIF and no drainage tube after the operation, compared with previous studies, appears to be safe and feasible to reduce recurrent back pain and leg pain after decompression in the treatment of lumbar degenerative disease.
Topics: Animals; Combined Modality Therapy; Dexamethasone; Disability Evaluation; Drug Delivery Systems; Gelatin; Glucocorticoids; Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain Measurement; Pain, Postoperative; Prospective Studies; Spinal Fusion; Spondylolisthesis; Surgical Sponges
PubMed: 33749136
DOI: 10.1111/os.12929 -
The Journal of Thoracic and... Jun 2015
Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Drug Carriers; Gentamicins; Humans; Mediastinitis; Sternotomy; Surgical Sponges; Surgical Wound Infection
PubMed: 25746031
DOI: 10.1016/j.jtcvs.2015.01.072 -
Case Reports in Surgery 2013A 39-year-old woman was referred for removal of cosmetic breast implants and related siliconoma. After an exchange of breast implants at a private clinic a year...
A 39-year-old woman was referred for removal of cosmetic breast implants and related siliconoma. After an exchange of breast implants at a private clinic a year previously, she had asymmetry of the right breast, persistent pain, and a generally unacceptable cosmetic result. An MRI had shown a well-defined area with spots of silicone-like material at the upper pole of the right breast. Surgical removal of presumed silicone-imbibed breast tissue was undertaken, and surprisingly a gossypiboma was found in its place, which had not been identified on the MRI. Gossypiboma is the condition of an accidentally retained surgical sponge. This complication is also known as a textiloma, gauzoma, or muslinoma and is well described in other surgical specialties. However, it is extremely rare after plastic surgery, and this case illustrates the need for continued attention to the surgical count of sponges and instruments.
PubMed: 23476877
DOI: 10.1155/2013/808624 -
Postgraduate Medical Journal May 2005Epistaxis is one of the commonest ENT emergencies. Although most patients can be treated within an accident and emergency setting, some are complex and may require... (Review)
Review
Epistaxis is one of the commonest ENT emergencies. Although most patients can be treated within an accident and emergency setting, some are complex and may require specialist intervention. There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population with their associated morbidity who often require more intensive treatment and subsequent admission. Treatment strategies have been broadly similar for decades. However, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Recent evidence suggests that this, combined with the use of stepwise management plans, should limit patient complications and the need for admission. This review discusses the various treatment options and integrates the traditional methods with modern techniques.
Topics: Catheterization; Cautery; Diathermy; Embolization, Therapeutic; Emergency Treatment; Epistaxis; Fibrin Tissue Adhesive; Humans; Hyperthermia, Induced; Laser Therapy; Ligation; Resuscitation; Surgical Sponges; Tampons, Surgical; Therapeutic Irrigation
PubMed: 15879044
DOI: 10.1136/pgmj.2004.025007 -
Jornal Brasileiro de Pneumologia :... Aug 2021
Topics: Foreign Bodies; Humans; Postoperative Complications; Surgical Sponges
PubMed: 34406227
DOI: 10.36416/1806-3756/e20210083