Missing washer of the rib approximator? An easily overlooked foreign body

Iatrogenic Foreign bodies especially Gauze swab following surgery are well reported. We report a very unusual case of a loose washer from SELLARS rib approximator, which came out loose in a thoracotomy wound. It was not recognised till reported missing by the central surgical supply department. The foreign body was identified and removed successfully. This case highlights the importance of checking the small connections of the instrument as a routine and especially if an instrument become loose.