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The mistakes of surgeons: "gossypiboma"
1Department of General Surgery, Dicle University, Faculty of Medicine, Diyarbakir, Turkey.
Purpose:
A foreign body retained in the abdominal cavity following surgery is a serious and medicolegal problem. To emphasize the importance of this operative iatrogenic complication, we reviewed our experience with six patients who had retained abdominal gossypibomas.
Methods:
The records of six patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital, between January 1994 and December 2000, were retrospectively reviewed.
Results:
Four of the six patients were female and two male. Previously, of the patients, three underwent elective operations and three were operated on for emergency. Types of previous operation were gynaecological in three cases, gastrointestinal in two cases and hepatobiliary in one case. The most common symptoms were mass, nausea, vomiting, abdominal distension and pain. The intestinal obstructions and pseudotumoral syndrome were determined in three and two cases, respectively. Abdominal ultrasonography clearly demonstrated the gossypiboma in four of our patients and CT demonstrated a more precise image of forgotten surgical sponges in the other two patients. One patient died due to ventricular fibrillation, the other five patients were discharged healthfully.
Conclusion:
Small sponges should not be used during laparotomy. Compresses should only be used intraperitoneally, one by one, mounted on a forceps. Before closing the peritoneum, the surgeon should completely explore the abdominal cavity.
Insights
Retained surgical sponges, or gossypibomas, are a serious complication of abdominal surgery. Careful surgical technique and complete exploration of the abdominal cavity are crucial to prevent these retained foreign bodies.
Area of Science:
- Surgical safety and patient outcomes.
- Iatrogenic complications in abdominal surgery.
- Medical device-related complications.
Background:
- Retained surgical items, such as gossypibomas, represent a significant iatrogenic complication with medicolegal implications.
- This study reviews the experience with six patients who developed retained abdominal gossypibomas after surgery.
Observation:
- The study included six patients (4 female, 2 male) who underwent various abdominal surgeries (gynecological, gastrointestinal, hepatobiliary).
- Common presenting symptoms included abdominal mass, nausea, vomiting, distension, and pain, leading to complications like intestinal obstruction and pseudotumoral syndrome.
- Diagnostic imaging, including ultrasonography and CT scans, was utilized to identify the retained surgical sponges.
Findings:
- Four out of six patients were diagnosed with gossypibomas following abdominal surgery.
- The study identified key symptoms and complications associated with retained surgical sponges.
- While one patient died, five patients recovered after diagnosis and management.
Implications:
- The findings underscore the critical need for meticulous surgical practices to prevent retained foreign bodies.
- Recommendations include avoiding small sponges during laparotomy and ensuring thorough exploration of the abdominal cavity before closure.
- Implementing standardized counting procedures and utilizing forceps for sponges can enhance surgical safety and reduce the incidence of gossypibomas.