Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

Abstract

Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intraabdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosisprior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.

Abdominal Gossypibomas: Computed Tomography Scanner Findings of a Series of 15 Cases

“…The CT scan is the most useful test for diagnosing gossypiboma and its complications [10] [16]. In practice, CT scans are usually ordered to rule out conditions other than gossypibomas.…”

“…Anatomopathological aspects of these forms appear distinct on CT scans. Granulomas correspond to spongy and pseudocystic forms, a late revelation which can even simulate an abdominal tumor [9] [10] [15] [16]. Forms with exudative inflammatory reactions correspond to the mixed forms in the scanner, expressing abscesses and peritonitis, and usually appearing soon after the first surgery.…”

Lower abdominal gossypiboma mimics ovarian teratoma: a case report and review of the literature

“…Cholecystectomy has been most commonly associated with the complication, followed by cesarean section and hysterectomy [2]. Women are especially exposed to high risk (63%) since gossypiboma often occurs after gynecological surgery [3, 6]. …”

“…Gossypiboma usually creates a diagnostic dilemma since clinical symptoms are always not characteristic, and the imaging methods are often uncertain [6, 15, 16]. Despite its rarity and diagnosis difficulty, gossypiboma should always be thought of in the differential diagnosis of indeterminate abdominal pain, infection, or a mass in any postoperative patient.…”

Laparoendoscopic Single-Site Surgery for Management of Gossypiboma Masquerading as an Adnexal Mass

“…2 Gossypiboma is an old surgical complication but remains problematic even in the modern setting, as this complication can cause significant morbidity with a potential risk of litigation. 3 Most cases of retained surgical items are discovered during the early postoperative period, when febrile morbidity, paralytic symptoms, and unusual abdominal pain manifests. 2,3 However, if gossypiboma shows a delayed presentation, remaining undetected for many years, this could pose a serious diagnostic and therapeutic challenge for the treating physician.…”