What are the definition, clinical presentation, imaging findings, and management of a gossypiboma?

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Gossypiboma: Definition, Clinical Presentation, Imaging, and Management

Definition

Gossypiboma (also called textiloma) is a retained surgical sponge or gauze left in the body after an operation, forming a mass lesion due to foreign body reaction. 1, 2, 3 The abdominal cavity is the most common site for retained surgical sponges, with reported incidence ranging from 1 in 1,000 to 1 in 15,000 intraabdominal operations. 1

Clinical Presentation

Timing and Symptoms

  • Presentation is highly variable, ranging from the early postoperative period to several decades after surgery. 1, 3, 4
  • Most cases are asymptomatic initially in the postoperative period. 2
  • Common presenting symptoms include:
    • Vague or intermittent abdominal pain 3, 5
    • Palpable abdominal mass or chronic lump 3, 5
    • Fever 5
    • Left or right iliac fossa pain 2, 3

High-Risk Surgical Contexts

  • Cesarean sections are the most commonly reported preceding operation in the literature. 2, 3, 5, 4
  • Bilateral orchiopexy and other abdominal procedures have been reported. 1
  • Any prior laparotomy or laparoscopic procedure converted to open surgery increases risk. 5

Imaging Findings

Diagnostic Challenges

Gossypiboma is notoriously difficult to detect on radiological investigations, with imaging often being inconclusive or misleading. 3 The varied and vague radiological appearance frequently poses a diagnostic dilemma. 3

CT Findings

  • Contrast-enhanced CT of the abdomen is the primary imaging modality that can reveal gossypiboma. 2, 5
  • CT may show a large intra-abdominal mass with variable characteristics. 5
  • Critical pitfall: Gossypiboma can be misdiagnosed as other pathology including hydatid cyst or mesenteric cyst on imaging. 1, 3

Other Imaging Modalities

  • Abdominal ultrasound may detect a mass but is nonspecific. 4
  • MRI can identify the mass but may not provide definitive diagnosis. 4

Management

Surgical Approach

The definitive treatment is surgical removal of the retained sponge, which can be accomplished via laparoscopy or open laparotomy depending on the degree of adhesions. 2, 4

Laparoscopic Removal

  • Laparoscopic removal is feasible and should be attempted when possible, even in the presence of adhesions. 2, 4
  • Successfully reported cases include removal after cesarean section. 2, 4

Open Laparotomy

  • Most cases require open approach due to dense adhesions to small bowel and surrounding structures. 3, 5
  • Exploratory laparotomy allows for safe dissection when the gossypiboma is densely adherent. 3
  • Incidental opening of the mass may reveal thick pus with the retained gauze. 1

Differential Diagnosis Considerations

Gossypiboma should be kept in mind as a differential diagnosis in any postoperative patient presenting with vague abdominal pain or chronic lump, even years after the operation. 3 Working diagnoses often include mesenteric cyst, hydatid cyst, or other intra-abdominal masses before surgical exploration confirms gossypiboma. 1, 3

Prevention Strategies

Prevention is far more important than cure and requires strict adherence to operating room protocols. 1

Mandatory Counting Protocols

  • Surgical sponges must be counted once at the start and twice at the end of all surgical operations. 1
  • Accurate sponge and instrument counts are essential. 1
  • When a discrepancy is found, radiologic evaluation should be performed immediately. 1

System-Level Interventions

  • Continuous medical training is necessary. 1
  • Strict adherence to operating room rules reduces incidence to a minimum. 1
  • While human errors cannot be completely avoided, systematic protocols significantly reduce risk. 1

Medicolegal Considerations

Gossypiboma is seldom reported in the literature because of medicolegal implications and fear of legal consequences. 3, 5 This underreporting means the true incidence is likely higher than published rates suggest. 3, 5

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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