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Gossipyboma final dt2
1. Presenting Author –
Dr. Amit Kharat
Co-Authors –
Dr. Dhaval K. Thakkar
Institution –
Dr. D. Y. Patil Medical College,
Pimpri, Pune
2. Clinical Profile:
23 years/female came with c/o severe pain in abdomen and PV bleeding
She was operated 11 days ago for suspected ruptured ectopic pregnancy for
which exploratory laprotomy was done.
Presently - Patient complained of having vague pain in abdomen since 2-3 days.
Figure 1 : Sonogram which shows inhomogeneous mass in right lower abdomen
with peripheral echogenic margins and reverberations.
3. Radio-opaque foreign body (in form of gauze piece with surgical thread ) is seen right
hypogastric region. Appearance is consistent with retained foreign body (in form of
gauze piece with surgical thread sutures)
4. Plain - CT Abdomen – going from cranial to caudal direction. Evidence of 10.0cm (CC) x
9.91 cm(Trans) x 6.75cm (AP) heterogeneously hypodense mass having spongiform
appearance with gas bubbles with few hyperdense strands is noted in RIF region. So
considering recent history of surgery, it is mostly likely to be gossypiboma.
6. A surgical sponge is the most common
type of retained foreign body (RFB).
The condition is sometimes called
gossypiboma, derived from the Latin
gossypium (cotton) and the Swahili boma
(place of concealment).
Frequent sites of gossypiboma formation
include:
1. Intrathoracic
a. pleural cavity
b. pericardial cavities
2. Abdominal cavity
Differential diagnosis
Abdomen
1. Abscess: CT findings of gossypiboma may
be indistinguishable from those of an
intraabdominal abscess.
2. Intestinal obstruction: Although
gossypiboma is rarely seen in daily clinical
practice, it should be considered in the
differential diagnosis of acute mechanical
intestinal obstruction in patients who
previously underwent laparotomy
GOSSYPIBOMA
7. Take Home Message
The diagnosis of a GOSSYPIBOMA is not often easy, and delayed diagnosis can be
problematic. Awareness of the typical radiologic appearances is critical to the
diagnosis of retained surgical sponges or swabs. Inadvertently retained sponges are
often clinically unsuspected and may be first recognized on imaging. Retained
Foreign Body should be considered in the differential diagnosis of any
postoperative patient who presents with pain, infection, or palpable mass
GOSSYPIBOMA
8. 1. Kim CK, Park BK, Ha H. Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J
Roentgenol. 2007;189 (4): 814-7.
2. Murphy CF, Stunell H, Torreggiani WC. Diagnosis of gossypiboma of the abdomen and pelvis. AJR Am J
Roentgenol. 2008;190 (6): W382.
3. Lo CP, Hsu CC, Chang TH. Gossypiboma of the leg: MR imaging characteristics. A case report. Korean J
Radiol. 4 (3): 191-3.
4. Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750.
5. Manzella A, Filho PB, Albuquerque E et-al. Imaging of gossypibomas: pictorial review. AJR Am J
Roentgenol. 2009;193 (6_supplement): S94-101.
REFERENCES
GOSSYPIBOMA
Editor's Notes
RADIOGRAPH OF THE ABDOMEN AP VIEW Radio-opaque Foreign body ( in form of gauze peice with surgical thread ) is seen rthypogastric region. Appearence is consistent with retained foreign body (in form of gauze peice with surgical thread sutures ((with paralytic illeus)) No evidence of free air under both the domes of the diaphragm.The pre and the pro peritoneal fat planes are normal. The visualized lumbar spine and the soft tissues are normal.No evidence of abnormally dilated bowel loops or air fluid levels.
