The document discusses retained textile foreign bodies (RTFBs), also known as gossypibomas, which are surgical sponges or towels accidentally left in a patient's body after a procedure, outlining their diagnosis using imaging tests, treatment requiring removal, potential complications, and importance of prevention through accurate counting of sponges before and after surgery. RTFBs can lead to serious issues like infection, fistula formation or bowel obstruction if not addressed, and prevention is critical given incidents continue to occur despite various counting guidelines and technologies introduced over the years.

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;

3. Gauze encapsulated in a cover of connective tissue.

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.

10. An axial T1-
weighted
magnetic
resonance
image through
the pelvis
shows a
circumscribed,
fairly
homogeneous
mass anterior to
the left psoas
muscle and the
vertebrae.

11. Treatment
• RTFB removal and management of possible
complications;
Approaches:
• Reopening the previous operative site;
• Endoscopical;
• Laparoscopical;
• Percutaneous radiological extraction;

12. Intra-operatory aspect of a gossypiboma occurred after an apendicectomy
procedure.

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;

14. Intra - operatory
aspect of a
fistula,
complication of a
gossypiboma
placed in
thyroidal lodge.

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;

20. Questions
?