General Principles of Intellectual Property: Concepts of Intellectual Proper...
Postoperative retained foreign bodies
1. The diagnosis, treatment and possible
prevention of postoperative retained
textile foreign body
Sandrina Maria Dascalescu
Scientific coordinator: Assistant Dan Andronic MD
“Gr.T.Popa” University of Medicine and Pharmacy, Iasi
2. General consideration
• Retained textile foreign body (RTFB) – usually
called gossypiboma
• Gossypiboma: from the Latin words gossypium
(cotton) and -oma (tumour or growth);
• Describes not only the forgotten postoperative
object, but also the subsequent body reactions;
4. Evolution
• Variable;
• Acute: septic course, with abscess, wound suppuration and
granuloma formation;
• Delayed, from months to years after surgery: fibroblastic
reaction, adhesion and encapsulation;
• Asymptomatic, may be discovered accidentally, during an
imaging investigation, a following surgical procedure or at
the autopsy;
• Symptomatic: vague symptoms;
5. Diagnosis
• Plain radiography (when surgical textile materials have been
impregnated with a radio-opaque marker)
• Gastrointestinal contrast series
• Ultrasonography
• Computerized tomography
• Magnetic resonance imaging
6. Plain X-ray of the abdomen Postero-anterior chest radiography
showing the radio-opaque marker showing an ill-defined opacity at the
of the retained sponge infero-lateral aspect of the left
in the centre of the abdomen. hemithorax.
7. Upper gastrointestinal
contrast study shows
a fistula (red
interrupted ring)
between
the cavity containing
the foreign body
(yellow arrows) and
the jejunum (green
arrow).
8. Ultrasonography feature: Well defined cystic structure with distinct
hyper-echoic wavy structures causing intense posterior acoustic
shadowing ( Abdominal RTFB).
9. CT appearance of a retained intra-abdominal towel (yellow narrow). Red
narrow represents the air bubbles within the foreign body which absorbed
the contrast agent.
13. Complications
• may appear during the surgical removal or simply
by ignoring the condition;
• fistula in the neighbouring organs;
• erosion into adjacent structures;
• necrosis of the intestinal wall;
• bowel obstruction;
• surgical complications: perforation of adherent
bowels – peritonitis;
15. Numbers
• In almost 25% of the RTFB cases death occurs;
• At The First Surgical Clinic "I. Tănăsescu – Vl. Buţureanu" of "St.
Spiridon“ Hospital of Iasi, between the years 1990 and 2009,
75,235 surgical procedures were made, 29 of them for a
retained textile foreign body removal. From these 29 cases, only 5
of them were registered as a result of a previous procedure in the
clinic. This leads to an incidence of 1:15,047 (0,007%)
or approximatively 1
case every 4 years.
• USA: more than 1500 cases every year
16. Risk factors
1. situations linked with emergency surgeries;
2. unexpected change in procedures;
3. more than one surgical team involved;
4. changes in nursing staff during the procedure;
5. high body mass index;
6. volume of blood loss;
7. procedures involving female or multi trauma patients;
8. failed surgical counts;
17. Where are the sponges? – Prevention:
Prevention
• radio-opaque marked materials usage in the OR;
• thorough exploration of all the abdominal
quadrants;
• standardized practices for counting surgical items
in all ORs;
• double counting of packs used, before and after the
closure of the operated site;
18. A three-step guide
for all OR staff,
called “Easy 1,2,3”
was developed as
part of a project
named NoThing
Left Behind,
leaded by Verna C.
Gibbs of the
University
of California and
San Francisco
Veterans Affairs
Medical Centre, in
order to simplify
the counting
procedure. .
19. • Plastic counter bag;
• Bar codes applied to all sponges, and with the use of a
bar code scanner the sponges can be counted on the back
table;
• Usage of radio-frequency identification systems;
• Intra-operative radiography;
