Gossypiboma

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Mini-laparotomy revealed gossypiboma (grasped by the clamp).
Surgical specimen (gossypiboma).

Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin gossypium (“cotton wool, cotton”) and the suffix -oma, meaning a tumor or growth, and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma.[1][2] "Textiloma" is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.[1]

Incidence and clinical presentation[edit]

The actual incidence of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations[2] and are most frequently discovered in the abdomen.[3] The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.[1]

Gossypibomas can often present, clinically or radiologically, similar to tumors and abscesses, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity.[3] Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma.[1] Symptoms may not present for long periods of time, sometimes months or years following surgery.[1]

Prevention[edit]

To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORN).[4] Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.[5] Other guidelines have been promoted by the American College of Surgeons and the Joint Commission.[6]

In most countries, surgical sponges contain radiopaque material that can be readily identified in radiographic and CT images, facilitating detection.[1] In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.[7] Some surgeons recommend routine postoperative X-ray films after surgery to reduce the likelihood of foreign body inclusion.[7]

See also[edit]

References[edit]

  1. ^ a b c d e f Kim HS, Chung TS, Suh SH, Kim SY (April 2007). "MR imaging findings of paravertebral gossypiboma". AJNR Am J Neuroradiol 28 (4): 709–13. PMID 17416826. 
  2. ^ a b Kiernan F, Joyce M, Byrnes CK, O'Grady H, Keane FB, Neary P (December 2008). "Gossypiboma: a case report and review of the literature". Ir J Med Sci 177 (4): 389–91. doi:10.1007/s11845-008-0197-0. PMID 18820991. 
  3. ^ a b Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (December 2009). "Imaging of gossypibomas: pictorial review". AJR Am J Roentgenol 193 (6 Suppl): S94–101. doi:10.2214/AJR.07.7132. PMID 19933682. 
  4. ^ "Recommended practices for sponge, sharp, and instrument counts. AORN Recommended Practices Committee. Association of periOperative Registered Nurses". AORN J 70 (6): 1083–9. December 1999. doi:10.1016/s0001-2092(06)62224-2. PMID 10635432. 
  5. ^ "The Retained Surgical Sponge", Agency for Healthcare Research and Quality
  6. ^ Gibbs VC, Coakley FD, Reines HD (May 2007). "Preventable errors in the operating room: retained foreign bodies after surgery--Part I". Curr Probl Surg 44 (5): 281–337. doi:10.1067/j.cpsurg.2007.03.002. PMID 17512832. 
  7. ^ a b Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY (February 2005). "Report of gossypiboma from the standpoint in medicine and law". World J. Gastroenterol. 11 (8): 1248–9. PMID 15754416. 

External links[edit]