Imaging of gossybioma dr ahmed esawy (retained missed towel surgical spongs) include different cases for oral radiodiagnosis examination all over the world CT /MRI Plain X ray images ultrasound post operative missed towel post operative missed spongs post operative missed cotton

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. An Article By
Dr. Ahmed Eisawy
MBBS M.Sc MD
THIS ARTICLE BY Dr/AHMED
ABD ALLAH EISAWY

3. IMAGING OF
GOSSYPIBOMA
(Retained Surgical Sponges
/missed towel)

4. • Gossypiboma is the technical term for
a surgical sponge accidentally left
inside a patient's body. It is derived
from the Latin "gossypium" (cotton)
and the Swahili ‫سواحلية‬" boma" (place of
concealment (‫ستر‬-‫خبأ‬.)

5. • The term "gossypiboma" denotes a mass
of cotton that is retained in the body
following surgery. Gossypiboma is a
medico-legal problem especially for
surgeons

6. • Actual occurrences are difficult to come by since
nearly all cases are settled out of court.
Statistical studies by researchers however put
the number of occurrences between 3000 and
5000 cases a year.
• Sponges are counted by hand before and after
surgeries. This method was codified into
recommended guidelines in the 1970 by the
Association of periOperative Registered Nurses
(AORN.(

7. CT&MRI
Criteria for gosspybioma
• 1-History of operation even since long times
• 2-Lesion outside anatomical configuration,no
communication with bowel
• 3-Inflammatory process like abscess
• 4-soft-tissue mass may show a whorled texture or a spongiform
pattern with contained gas bubbles
• 5-dense, enhanced wall,
• 6-containing an internal high-density area
• 7-Trapped air-bubbles. spongiform pattern of gas bubbles
• 8-Fluid collection either fluid filled or perilesion / paralesion
• 9-calcification

8. • DD : hematoma
pyogenic abscess
Cyst
tumor

9. • Sterile gas bubbles may be persistent and
can still be seen at 6 months after
placement of surgical sponges in bath
water

10. Case presentation
• A 74-year-old woman presented with
symptoms of small bowel obstruction due
to incomplete intraluminal migration of a
laparotomy towel 3 years after open
cholecystectomy and umbilical hernia
repair.

11. • Plain abdominal radiography did not show
any sign of a radio-opaque marker in the
abdomen.

12. • contrast enhanced abdominal
computerized tomography revealed a
round, well-defined soft-tissue mass with a
dense, enhanced wall, containing an
internal high-density area with air-bubbles
in the mid-abdomen.

13. • retained intraabdominal towel.

14. • Upper gastrointestinal
contrast study
showed a fistula

15. • 66-year-old woman with left flank pain and
high-grade pyrexia.

16. • Axial CT scan of abdomen and pelvis
with oral and IV contrast

17. • Axial T1 contrast-enhanced MR image

18. • Axial T2 (C) and
coronal T2 (D) MR
images

19. Case Report
A 60 year old woman underwent total
abdominal hysterectomy for uterovaginal
descent with recurrent pyometra. Eighteen
days later she presented with lower
abdominal pain. Clinical examination
revealed an ill-defined suprapubic mass.

20. • Sonogram

21. • Plain radiograph of
abdomen

22. • CT scan through the pelvis

23. • 27-year-old lady presented with discomfort
in periumbilical area since one month ago.
• previous history was a cesarean section
five years back.
• Vital signs were normal.
• On abdominal examination, a round
mobile mass was palpable.
• All routine lab data were normal.

24. • Abdominal X-ray was in favor of retained
sponge
• CT scan confirmed the diagnosis
• Exploratory laparotomy revealed an
encapsulated sponge surrounded by
omentum, which was removed .
• Postoperative course was uneventful.

25. • Plain X-ray of the
abdomen

26. • Abdominal CT scan

27. Surgical
specimen
(gossypiboma).
• Mini-laparotomy
revealed
gossypiboma
(grasped by the
clamp).

28. • Case Post contrast axial CT scan

29. CT image.
Scout radiograph.

30. Retained sponge in 69-year-old man 4 weeks after
aortofemoral bypass.
Radiograph obtained
Axial CT image

31. • -Axial CT image

32. CT
• Axial CT image

33. A mixed gas,
fluid and soft
tissue density
mass is noted
adjacent to the
right pelvic side
wall (arrow).
• CT scan

34. CT scan
• . A mixed gas, fluid and soft tissue density mass

35. CT
• cystic mass displacing
the duodenum.

36. • The US scan

37. • (a) Contrast material-enhanced CT
• (b) Right intercostal sonogram

38. • (a) Enhanced CT scan
• (b) Plain radiograph..

39. scans obtained 18
years after
cholecystectomy.
• Sagittal sonogram

40. Precontrast (a)
and postcontrast (b) CT scans
(c) A high-density spot in the rim
of the mass is calcification, not
a sponge marker.

41. • (a) Enhanced CT scan.
• (b) Sonogram (left subcostal section).

42. • Enhanced CT scan

43. • A, Longitudinal sonogram .
• B, CT of mid abdomen

44. • A, Transverse sonogram.
• B, CT

45. Well marginated
round mass

46. Well defined
oviod soft
tissue mass in
omental area (

47. • US images of the
abdomen

48. • Barium enema

49. • Case before for barium enema. Axial CT image

50. • Computerized tomography abdomen image.

51. Transdiaphragmatic migration of forgotten gauze
sponge: an unreported entity of lung abscess
• Spiral computed
tomogram of thorax

52. Wavy amorphous hyperechioc focus within hyperechioc mass .the echogenic
component with strong posterior acoustic shadowe due to retained sponge

53. MRI

54. MR imaging of a retaiend sponge in a 56 year old man complaining of
frequency 5 months after radical retropubic prostatectomy.
• A-Axial T1 image
following contrast
demonstrates.
• B-Axial T2 weighted
image

55. • 52-year-old woman with gossypiboma in right
adnexa mimicking ovarian fibroma or
degenerated uterine myoma.

56. • Axial) T1
• Axial contrast-enhanced T1
•
• Axial T2-shows

57. • 62-year-old woman with large
gossypiboma in left lower quadrant
mimicking retroperitoneal soft-tissue tumor

58. • Axial T1
• Axial T2
• Axial contrast-enhanced T1

59. • 30-year-old woman with gossypiboma in
left nephrectomy site

60. • T1 and T2 images
• contrast-enhanced
spoiled gradient-
echo T1-weighted
image

61. • Histopathologically, the peripheral wall
showed granulomatous inflammation with
massive fibrosis and foam cell and
multinucleated giant cell infiltrations,
whereas the whorled stripes within the
central portion were gauze fibers.