Gossypiboma of the Abdomen and Pelvis; A Recurring Error
Gilbert Maranya1,2, Heltam Maganga1, Bernard Mwero1,2
Coast Province General Hospital, Mombasa, Kenya
Moi Hospital, Voi, Kenya
Correspondence to: Dr. Gilbert Maranya, P.O Box 91066-80103 Mombasa, Kenya.
Introduction: Gossypiboma is a retained surgical sponge commonly in the abdomen and pelvis. Risk factors include emergency and prolonged surgery. Attendant complications are visceral obstruction, perforation, sepsis, fistulae, and diagnostic dilemmas. The objective of this write up is to report the occurrence of gossypiboma and recommend corrective measures. Methods: A retrospective audit undertaken at two hospitals in the Coast region of Kenya between 2008 and 2016 involved 11 patients. Results: A female preponderance of 73% was observed. The mean age was 32 years. Emergency surgery accounted for 73% of the patients; with a caesarian section dominating. Most patients were operated upon; while in one patient with uterine cervical tear and episiotomy, the sponge was extruded spontaneously per vaginum. One caesarian section patient had two sponges. In another two caesarian section patients, the sponges had no radiopaque marker. Mortality occurred in 3 (27%) patients. Conclusion: The incidence of gossypiboma can be minimized by proper gauze and instrument management intraoperatively. The change in operating personnel during surgery is discouraged.
Keywords: Gossypiboma, Retained surgical sponges, Textilloma
Ann Afr Surg. 2017;14(1): 44-47.
© 2017 Annals of African Surgery. This work is licensed under the Creative Commons Attribution 4.0 International License.
Gossypiboma is a retained surgical sponge. It is a rare but ubiquitous medical error (1-3). There is a reluctance to publish this matter for fear of medico-legal implications, and criticism by the public and medical profession (4-6). Gossypiboma usually occurs in the abdominal and pelvic cavities (7). The risk for gossypiboma is higher in emergencies, prolonged surgery, operations entailing more than one major procedure, more than one surgical team, failure of surgical or incorrect counts, unexpected intraoperative factors and high intraoperative blood loss (2, 7-9).
Presentation is variable from immediate to late, with some sponges remaining asymptomatic(4). Sequels of gossypiboma are sepsis, visceral perforation, penetration, obstruction, fistulae formation, intraluminal migration and death (3, 7). It may also present as a mass mimicking a tumor or tumor recurrence. Gossypiboma increases medical costs through investigations, surgical procedures, and morbidity (1). Radiological investigations have high diagnostic value and comprise ultrasonography, plain abdominal radiography and computerized tomography scanning (7, 10).
Gossypiboma may be prevented by counting sponges before and after surgery, the use of sponges