Top

Published in:

01-11-2010 | Overview

Retained surgical sponges: what the practicing clinician should know

Authors: George H. Sakorafas, Dimitrios Sampanis, Christos Lappas, Eva Papantoni, Spyros Christodoulou, Aikaterini Mastoraki, Michael Safioleas

Published in: Langenbeck's Archives of Surgery | Issue 8/2010

Abstract

Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.

Wilson C (1884) Foreign bodies left in the abdomen after laparotomy. Gynecol Tr 9:109–112

Crossen HS, Crossen DF (1940) Foreign bodies left in the abdomen. CV Mosby Co, St Louis (Mo)

Hyslop JW, Maull KI (1982) Natural history of the retained surgical sponge. South Med J 75:657–660PubMed

Cima RR, Kollengode A, Garnatz J et al (2008) Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg 207:80–87CrossRefPubMed

Gawande AA, Studdert DM, Orav EJ et al (2003) Risk factors for retained instruments and sponges after surgery. N Engl J Med 348:229–235CrossRefPubMed

Rappaport W, Haynes K (1990) The retained surgical sponge following intra-abdominal surgery. Arch Surg 125:405–407PubMed

Yildirim S, Tarim A, Nursal TZ et al (2006) Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg 391:390–395CrossRefPubMed

Yamamura N, Nakajima K, Takahashi T et al (2008) Intra-abdominal textiloma. A retained surgical sponge mimicking a gastric gastrointestinal stromal tumor. Surg Today 38:552–554CrossRefPubMed

Apter S, Hertz M, Rubinstein ZJ et al (1990) Gossypiboma in the early postoperative period: a diagnostic problem. Clin Radiol 42:128–129CrossRefPubMed

10.

Botet del Castillo FX, Lopez S, Reyes G et al (1995) Diagnosis of retained abdominal gauze swabs. Br J Surg 82:227–228CrossRefPubMed

11.

Lincourt AE, Harrell A, Cristiano J et al (2007) Retained foreign bodies after surgery. J Surg Res 138:170–174CrossRefPubMed

12.

Bani-Hani KE, Gharaibeh KA, Yaghan RJ (2005) Retained surgical sponges (gossypiboma). Asian J Surg 28:109–115CrossRefPubMed

13.

Kaiser CW, Friedman S, Spurling KP et al (1996) The retained surgical sponge. Ann Surg 224:79–84CrossRefPubMed

14.

Mouhsine E, Halic N, Garofalo R et al (2005) Soft-tissue textiloma: a potential diagnostic piftall. Can J Surg 48:495–496PubMed

15.

McLeod RS, Bohnen JMA, Members of the CAGS (2004) Risk factors for retained foreign bodies after surgery. Can J Surg 47:57–59PubMed

16.

Gibbs VC (2005) Patient safety practices in the operating room: correct-site surgery and nothing left behind. Surg Clin N Am 85:1307–1319CrossRefPubMed

17.

Helmich RL (2000) On error management: lessons from aviation. BMJ 320:781–785CrossRef

18.

Einstein GO, McDaniel MA, Williford CL et al (2003) Forgetting of intentions in demanding situations is rapid. J Exp Psychol Appl 9:147–162CrossRefPubMed

19.

Gonzales-Ojeda A, Rodriguez-Alcantar DA, Arenas-Marquez H et al (1999) Retained foreign bodies following intra-abdominal surgery. Hepatogastroenterology 46:808–812

20.

Lauwers PR, Hee RHW (2000) Intraperitoneal gossypiboma: the need to count sponges. World J Surg 24:521–527CrossRefPubMed

21.

Sturdy JH, Baird RM, Gerein AN (1967) Surgical sponges: a cause of granuloma and adhesion formation. Ann Surg 165:128–134CrossRefPubMed

22.

Godara R, Marwah S, Karwasra RK et al (2006) Spontaneous transmural migration of surgical sponges. Asian J Surg 29:44–45CrossRefPubMed

23.

Sahin-Akyar G, Yagci C, Aytac S (1997) Pseudotumor due to surgical sponge: gossypiboma. Australas Radiol 41:288–291CrossRefPubMed

24.

Cevik I, Dillioglugil O, Ozveri H, Akdas A (2008) Asymptomatic retained surgical gauze towl diagnosed 32 years after nephrectomy. Int Urol Nephrol 40:885–888CrossRefPubMed

25.

Cokelaere K, Vanvuchelen J, Michielsen P et al (2001) Epithelioid angiosarcoma of the splenic capsule. Report of a case reiterating the concept of inert foreign body tumorigenesis. Virchows Arch 438:398–403CrossRefPubMed

26.

Gencosmanoglu R, Inceoglu R (2003) An unusual cause of small bowel obstruction: gossypiboma. BMC Surg 3:6CrossRefPubMed

27.

Dharamsi RD, Jesudason SRB, Rolston DDK (1990) Chronic watery diarrhea due to a surgical pack in the ileal lumen. J Clin Gastroenterol 12:239–241CrossRefPubMed

28.

Risher WH, McKinnon WM (1991) Foreign body in the gastrointestinal tract: intraluminal migration of laparotomy sponge. South Med J 84:1042–1045PubMed

29.

Lourenco SC, Baptista A, Pacheco H, Malhado J (2008) A misplaced surgical towel-a rare cause of fever of unknown origin. Eur J Intern Med 19:377–378CrossRefPubMed

30.

Mentes BB, Yilmaz E, Sen M et al (1997) Transgastric migration of a surgical sponge. J Clin Gastroenterol 24:55–57CrossRefPubMed

31.

Alis H, Soylu A, Dolay K et al (2007) Surgical intervention may not always be required in gossypiboma with intraluminal migration. World J Gastroenterol 13:6605–6607CrossRefPubMed

32.

Lin TY, Chuang CK, Wong YC et al (1999) Gossypiboma: migration of retained surgical gauze and spontaneous transurethral protrusion. BJU Int 84:879–880CrossRefPubMed

33.

Yaycioglu O, Ulusan S, Ezer A et al (2007) Uretoreoappendiceal fistula due to gossypiboma. Urol Int 79:187–188CrossRefPubMed

34.

Silva CS, Caetano MR, Silva EA et al (2001) Complete migration of retained surgical sponge into ileum without sign of open intestinal wall. Arch Gynecol Obstet 265:103–104CrossRefPubMed

35.

Serra J, Matias-Guiu X, Calabuig R et al (1988) Surgical gauze pseudotumor. Am J Surg 155:235–237CrossRefPubMed

36.

Richards WO, Keramati B, Scovill WA (1986) Fate of retained foreign bodies in the peritoneal cavity. South Med J 79:496–498PubMed

37.

Imren Y, Tasoglu I, Ozkose Z (2006) A different intracardiac mass: retained sponge. Echocardiography 23:322–323CrossRefPubMed

38.

Olnick HM, Weens HS, Rogers JV (1955) Radiological diagnosis of retained surgical sponges. JAMA 159:1525–1527

39.

Arpit N, Abhijit R, Narlawar RS, et al. Gauze pad in the abdomen : can you give the diagnosis without knowing the history ?. J Radiol (http://www.jradiology.com/arts/50.pdf)

40.

Prasad S, Krithnan A, Limdi J, Patankar T (1999) Imaging features of gossypiboma: report of two cases. J Postgrad Med 45:18–19PubMed

41.

Granetzny A, Holtbecker N, Thomas H et al (2008) Misinterpretation of a pulmonary GI anastomosis stapler line as a retained foreing body. Chest 133:281–283CrossRefPubMed

42.

Choi BI, Kim SH, Yu ES et al (1988) Retained surgical sponge: diagnosis with CT and sonography. AJR Am J Roentgenol 150:1047–1050PubMed

43.

Revesz G, Siddiqi TS, Buchheit WA et al (1983) Detection of retained surgical sponges. Radiology 149:411–413PubMed

44.

Sugano S, Suzuki T, Linuma M et al (1993) Gossypiboma: diagnosis with ultrasonography. J Clin Ultrasound 21:289–292CrossRefPubMed

45.

Chau WK, Lai KH, Lo KJ (1984) Sonographic findings of intraabdominal foreign bodies due to retained gauze. Gastrointest Radiol 9:61–63CrossRefPubMed

46.

Cheng TC, Chou AS, Jeng CM et al (2007) Computed tomography findings of gossypiboma. J Chin Med Assoc 70:565–569CrossRefPubMed

47.

Parienty RA, Pradel J, Lepreux JF et al (1981) Computed tomography of sponges retained after laparotomy. J Comput Assist Tomogr 5:187–189CrossRefPubMed

48.

Kalovidouris A, Kehagias D, Moulopoulos L, Gouliamos A, Pentea S, Vlachos L (1999) Abdominal retained surgical sponges: CT appearance. Eur Radiol 9:1407–1410CrossRefPubMed

49.

Kopka L, Fischer U, Gross A et al (1996) CT of retained surgical sponges (textilomas): pitfalls in detection and evaluation. J Comput Assist Tomogr 20:919–923CrossRefPubMed

50.

Sheehan RE, Sheppard MN, Hansell DM (2000) Retained intrathoracic surgical swab: CT appearance. J Thorac Imaging 15:61–64CrossRefPubMed

51.

Sugimura H, Tamura S, Kakitsubata Y et al (1992) Magnetic resonance imaging of retained surgical sponge. Clin Imaging 16:259–262CrossRefPubMed

52.

Kim CK, Park BK, Ha H (2007) Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J Roentgenol 189:814–817CrossRefPubMed

53.

Dux M, Ganten M, Lubienski A et al (2002) Retained surgical sponge with migration into the duodenum and persistent duodenal fistula. Eur Radiol 12:74–77CrossRef

54.

Ghersin E, Keidar Z, Brook OR et al (2004) A new pitfall on abdominal PET/CT: a retained surgical sponge. J Comput Assist Tomogr 28:839–841CrossRefPubMed

55.

Jain M, Sawhney S (1995) Gossypiboma: ultrasound-guided removal. J Clin Ultrasound 23:321–323CrossRefPubMed

56.

Uranus U, Schauer C, Pfeifer J et al (1995) Laparoscopic removal of a large laparotomy pad forgotten in situ. Surg Laparosc Endosc 5:77–79PubMed

57.

Erdil A, Kilciler G, Ates Y et al (2008) Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus. Inter Med 47:613–615CrossRef

58.

Singh R, Mathur RK, Patidar S et al (2004) Gossypiboma: its laparoscopic diagnosis and removal. Surg Laparosc Endosc Percutan Tech 14:304–305CrossRefPubMed

59.

Pierson MA (1995) Patient and environment safety. In: Mecker M, Rothrock J (eds) Alexander’s care of the patient in surgery, 10th edn. Mosby-Year Book, St Louis, pp 19–34

60.

AORN Recommended Practices Committee (2006) Recommended practices for sponge, sharps, and instruments counts. AORN J 433:412–418

61.

Sarr MG (2005) Retained foreign bodies—why do we still allow them to occur? Surgery 137:304–305CrossRefPubMed

62.

Dossett LA, Dittus RS, Speroff T et al (2008) Cost-effectiveness of routine radiographs after emergent open cavity operations. Surgery 144:317–321CrossRefPubMed

63.

Macario A, Morris D, Morris S (2006) Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology. Arch Surg 141:659–662CrossRefPubMed

64.

Rogers A, Jones E, Oleynikov D (2007) Radiofrequency identification (RFID) applied to surgical sponges. Surg Endosc 21:1235–1237CrossRefPubMed

65.

Fabian CE (2005) Electronic tagging of surgical sponges to prevent their accidental retention. Surgery 137:298–301CrossRefPubMed

Title: Retained surgical sponges: what the practicing clinician should know
Authors: George H. Sakorafas
Dimitrios Sampanis
Christos Lappas
Eva Papantoni
Spyros Christodoulou
Aikaterini Mastoraki
Michael Safioleas
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 8/2010
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-010-0684-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Retained surgical sponges: what the practicing clinician should know

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2010

Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage

Human errors in (inhuman?) triage

Effects of a clinical pathway of pulmonary lobectomy and bilobectomy on quality and cost of care

An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis

Microvascular response to calcium phosphate bone substitutes: an intravital microscopy analysis

Robotic partial splenectomy for hydatid cyst of the spleen