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INTRA ABDOMINAL GOSSYPIBOMA: A SURGEON'S NIGHTMARE RESOLVED WITH LAPAROSCOPY
Soukat A. Khan
*, Lovenish Bains
General Surgery , Maulana Azad medical College, Karimpur, West Bengal, India
BACKGROUND Gossypiboma, is a rare but significant medical complication caused by a retained surgical sponge. It is completely avoidable. Initially asymptomatic, it can later cause vague symptoms, making diagnosis clinically challenging. It is commonly misinterpreted as a tumor or abscess, and patients typically have a history of previous surgery. Despite advancements in surgical techniques, gossypiboma can result in significant morbidity. Its diagnosis is difficult due to nonspecific clinical symptoms and inconclusive imaging findings, posing a serious risk to patient health. We present a case that emphasizes the critical importance of patient safety and strict adherence to surgical safety checklists.
METHOD A 51-year-old woman presented with abdominal pain, fever, and pus discharge from a drain site, approximately four months after undergoing cholecystectomy and CBD exploration at an outside facility. On abdominal examination, a 4 x 2 cm abscess was noted in the right abdomen, which was subsequently drained. The patient continued to have regular pus discharge from the site. Ultrasonography revealed multiple pockets of heterogeneous collection in the right lower abdominal wall with surrounding inflammatory changes. A computed tomography scan was performed, which suggested the presence of a suspected gossypiboma in the abdomen.
RESULT The patient underwent a diagnostic laparoscopy. Intraoperatively, a mass was found adherent to the abdominal wall, densely covered by omentum and bowel loops on one side. After careful dissection, an opening was made into the mass, from which pus drained, revealing a retained abdominal mop. The mop was removed by enlarging drain site, and the wound was thoroughly irrigated. Postoperatively, the patient showed significant symptomatic improvement, with an uneventful recovery and resolution of the pus discharge.
DISCUSSION Gossypiboma labelled as an unexpected guest in the abdomen is a simple human error which can lead to potentially life-threatening complications for the patient, as well as legal ramifications that can damage the reputations of both the doctor and the hospital. The incidence of gossypiboma is often underreported, primarily due to the legal consequences of detection and because many patients remain asymptomatic. Clinical presentation varies depending on the location of the foreign body and the type of inflammatory response from the host. The recommended treatment is excision, which can be performed by open or laparoscopic surgery aiming to prevent complications that contribute to high morbidity rates. Prevention is the most important strategy. The use of a surgical safety checklist is vital in minimizing such errors. By ensuring accurate sponge counts and adherence to systematic procedures, the checklist enhances patient safety, reduces surgical errors and improves overall surgical outcomes.
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