Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Review of the Literature

Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Discussion Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Literature Review

Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Clinical Discussion: Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

Foreign Body Granuloma

Penetration of foreign bodies may present a diagnostic challenge to the surgeon. The foreign body granuloma is a biological response of tissue to any foreign body in the tissue. The pathway of arriving to the diagnosis of foreign body granuloma becomes difficult when patient presents with non specific symptoms such as pain/ swelling, and in history- no recollection of previous trauma. It can be of two types- a) Iatrogenic gossypiboma by retained surgical sponge intra-operatively b) Granulation by a penetrating foreign body such as wooden splinter or other materials. -The most frequent reported injury is to hand, thigh, knee and feet; these may be limited to soft tissue of may be intra articular. The time and type of presentation varies according to the immune status of the individual. In cases, where history of trauma is uncertain, the presentation is very late and the radiographic appearance may be confusing - Median time of presentation: 4 months to 20 years

Surgical Sponge Retained in Femoral Canal for 22 Years: A Case Report

Background: Retained surgical items (RSIs) are not very common in the orthopedic surgery. Here, we are reporting a case of a sponge pad left in the femoral canal for 22 years. We could not find any other reported case of retained surgical sponge in the femoral canal and that is what makes this case report unique. Case Report: The patient was a 42 year-old man who underwent surgery for the fixation of a fractured femur 22 years ago. On August 2020, this patient was seen complaining about pain at the surgical site. The assessments revealed a sponge pad retained in the femoral canal, which was removed by surgery. The union of fractured bone did not take place in the first surgery, so after 6 months a second surgery was performed and the dynamic compression plate (DCP) placed was successfully replaced with an intramedullary nail. Conclusion: The surgeon could not detect the pad 22 years ago and the patient had no significant symptom all this time. The most important take-away lesson of this paper is that retention of surgical pads could also occur with correct gauze counting, so detection and prevention protocols for RSIs must be taken seriously.

A Word of Caution for Gossypiboma

Gossypiboma, a retained nonabsorbable surgical sponge, is a major safety issue despite being infrequent, causing serious malpractice debates. In addition to this, it may mimic a range different disease within the thorax and even have unpleasant clinical presentations even after years.In this article, we report four gossypiboma cases with nonspecific clinical presentations to emphasize the importance of keeping this diagnosis in mind with all patients who have had a previous operation.

Retained surgical sponge presenting as a case of intestinal obstruction

Retained surgical sponge or gossypiboma is a term used to describe a retained swab in the body after operation. There are different surgical materials that can be left in the abdomen during operation such as sponge, artery forceps, scissors, and pieces of broken instrument. Mop is the most commonly retained foreign body. Inadvertent retention of foreign body in the abdomen often requires another operation, increasing the morbidity and mortality in these patients. Despite the complications associated with this condition, they are rarely published because of medicolegal implications. We report a case of 28-year-old woman who presented on account of 9 months history of colicky abdominal pain, abdominal distention and mass following open myomectomy in a private hospital.

Gossypiboma - A Diagnostic Dilemma

A surgical sponge is the most common type of retained foreign body (RFB) also known as a gossypiboma (gossypium = cotton, boma = concealment). It is mostly asymptomatic but can lead to a host of symptoms in the patient ranging from pain in the abdomen to anorexia and weight loss. It poses a diagnostic challenge not just for the surgeon but also the radiologist as it can mimic an intraabdominal mass. Here we present a case of a 58 yrs old male who presented with dysphagia and abdominal pain on and off who was radiologically diagnosed as a case of gastric mass and subsequently underwent exploratory laparotomy where it was proven to be a gossypiboma. The case attempts to highlight the importance of keeping gossypiboma as a differential diagnosis for patients with vague abdominal pain and history of a surgery in the past. Key words: gossypiboma, sponge, abdominal pain, computed tomography, foreign body.

Spectrum of CECT Findings of Retained And Migrated Surgical Items In Abdomen – A Series of Seven Cases.

Background: Various retained surgical items often present a diagnostic dilemma to the interpreting radiologist. These items include retained surgical sponge (gossypiboma), misplaced, migrated catheters, broken instruments, irrigation sets, and a variety of surgical paraphernalia. Such foreign bodies present with varying imaging findings and can often mimic other diseases radiologically.Case presentations: We present a series of seven interesting cases of retained surgical mops (case 1, 2 and 3), broken and retained surgical instrument (case 4), migrated plastic biliary stent (case 5), migrated contraceptive device (case 6) and surgically placed hemostatic agent (case 7)Conclusions: Familiarity with the variable imaging findings and communication with the clinician can facilitate timely management for these patients.

Development of bladder plate calculus on missed sutured surgical sponge following primary bladder exstrophy repair

Bladder Exstrophy (BE) has been considered as a rare congenital malformation of the genitourinary system, with an estimated incidence of approximately 1 per 50,000 live births [1]. The management of this anomaly is complex, involving several surgical reconstructions with numerous challenges to achieve anatomically, functionally, and cosmetically satisfactory outcomes [2]. Furthermore, the management must be early in the first months of life for better functional and cosmetic results [3,4]. Wound dehiscence, urethral outlet obstruction, bladder prolapsed, renal and bladder calculi are among the main complications following failed primary BE closure [5]. Urinary stone formation is estimated to be around 15% following bladder closure, in repaired BE patients, especially in cases living in poor or rural regions [6]. Bladder stone formation may occur following infra-vesical obstruction, neurogenic voiding dysfunction, urinary tract infection, foreign bodies, and metabolic risk factors years after reconstructive surgery [7]. Here, we report a 6-yearold boy with failed BE repair at an early age that was complicated by late surgery outcomes and secondary stone formation on missed sutured surgical sponge post-operatively.