Retained intra-abdominal artery forceps – An unusual cause of intestinal strangulation

Abstract

Context:Surgical instruments and materials continue to be retained in the peritoneal cavity despite precautionary measures. Even though uncommon it is also under-reported and carries serious medico-legal consequences. Gauzes and sponges (gossypiboma) are the most commonly retained materials and intra-abdominal retained artery forceps are much rarer but when they do occur lead to chronic abdominal pain and can be a rare cause of intestinal obstruction or strangulation with significant morbidity and mortality.Case Report:We present a case of intraabdominal retained artery forceps in a 70-years-old lady who underwent laparotomy with splenectomy for a large spleen in a peripheral hospital. Upon discharge she continued to complain of intermittent abdominal pain of increasing severity. 12 months later she presented to us with an acute (surgical) abdomen requiring another laparotomy. At laparotomy she had strangulated/gangrenous lower jejunual and upper ileal bowel loops, the small bowel mesentery of this area being tightly trapped between the jaws of the retained artery forceps. She had gut resection and enteroanastomosis. Unfortunately she died from continuing sepsis on the second post-operative day.Conclusion:Retained instruments in intra-abdominal surgery can cause serious complication and should be treated surgically. High index of suspicion and appropriate investigations like plain abdominal X-ray, abdominal ultrasound and CT and MRI scans should be instituted in patients who develop chronic abdominal symptoms following laparotomy. Preventive measures against retained instruments must follow strict laid down protocols for surgical instruments handling in theatre.

Retained Artery Forceps that Migrated into the Large Intestine

“…There are reports of retained artery forceps causing intestinal obstruction [8] and internal fistulation [9], but reports of intraluminal migration of retained foreign body has always mentioned the surgical gauze [5,7]. This patient is likely the first case to have had intraluminal migration of the retained artery forceps.…”

Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases

“…We had only 129 cases of needles, surpassed even by 237 surgical clamps, seldom mentioned in the medical literature. The most widespread RFB preventive measure is the instrumental counting, which, in many surgical centers, is not standardized or uses only textiles counting [17][18][19] . Even in the places that follow all recommendations of the Association of Perioperative Registered Nurses (AORN), needles represent the most discrepancies in counting 20 .…”

Retained Surgical Items in Inguinal Canal: A Case Report and Literature Review

“…RSI is grossly underreported by surgeons, although they are reportable events. This is because of a surgeon’s fear of legal issues or unwillingness to denounce an error [ 1 ]. The average costs to repair and remove RSI can range anywhere from 60000$ per hospital stay to millions of dollars after settle malpractice claims [ 2 ] [ 3 ].…”