Abscess due to textiloma (gossypiboma: Retained surgical cottonoid)

Abstract

Background:Surgical site infections following spinal surgery, including spinal abscesses, are rare but serious as they are major causes of morbidity, and even mortality. They are, however, rarely attributed to infected, retained surgical cottonoids or sponges (textiloma or gossypiboma) inadvertently left in an operative field.Case Description:A 53-year-old female with a history of two prior spinal operations at the L4-S1 levels (11 and 2 years previously) presented over a few weeks with the acute onset of a cauda equina syndrome (e.g., paraparesis and acute urinary incontinence). The patient demonstrated a mildly elevated white blood cell count (12,600/mm3) and abnormally increased C-reactive protein level that correlated with the magnetic resonance imaging that showed a dorsal epidural abscess extending from the L4 to S1 levels. At surgery, an encapsulated posterior epidural abscess was drained. Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid and was removed from the antero-inferior portion of the abscess wall at S1. Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca. After 2 months of ciprofloxacin, the patient's infection cleared but the motor deficit only partially resolved.Conclusion:Most spinal textilomas (gossypibomas) are aseptic and are found in paraspinal areas without neurological symptoms or sequelae. These lesions may remain silent for years and may only rarely cause neurologic or infectious symptoms/signs. Notably, textilomas following spinal surgery may be largely avoided if proper cottonoid and sponge counts are done prior to closing spinal wounds.

Gauze for concern: A Case Report and systematic review of delayed presentation of paraspinal textiloma

“…Important risk factors predisposing to the occurrence of textiloma include emergency surgical intervention, complex and protracted surgeries, change in surgical approach during the procedure, surplus blood loss necessitating the use of a larger number of sponges, inaccuracies in pre-and post-surgical sponge counts and a greater body-mass-index of the patient (9)(10)(11).…”

DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature

“…[15] Indeed, CES diagnosis often becomes a mounting medicolegal issue with at least one study documenting that in 96% of cases of CES brought to a malpractice insurance organization, 65% progressed to claims by the affected patients, and 48% of these cases resulted in payment of compensation for damages. [34] It must be noted that rare cases of CES resulting from iatrogenic causes such as retained surgical cottonoids,[4] epidural steroid injections,[10] and even a pathological engorgement of the epidural venous plexus after elective lumbar microdiscectomy[32] have been reported in literature with additional consequences. Furthermore, studies have shown that a delay in treatment typically results in adverse legal decision highlighting the requisite expedited intervention.…”

About an unusual mesenteric cyst.

“…Le terme Textilome signifie la présence d'une réaction inflammatoire induite par un corps textile au contact des tissus. C'est une complication post opératoire rare et ubiquitaire dans l'organisme [2]. Son incidence varie de 0.001 à 0.01%.…”