Asian Journal of Case Reports in Surgery

Gossypiboma Complicating Conservative Treatment of Post-Operative Fistula and a Proposed Classification System

Aremu Isiaka *

Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Agodirin Olayide

Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Olatoke Samuel

Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Aremu Latifat

Department of Radiology, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Gossypiboma denotes surgically retained cotton or sponge following intra-abdominal procedures. The incidence of gossypiboma as a cause of small bowel obstruction still remains very low, probably due to under reporting.

Presentation of Case: A case report of a 45 yr old female with mechanical small bowel obstruction from gossypiboma. She had exploratory laparotomy with extraction of three pieces of rolled up gauzes.

Discussion: The theory for intraluminal gossypiboma is the suppurative inflammation and necrosis with transmigration of the retained intra-abdominal gauze through a spontaneous enteric fistulation. We propose a possible alternative theory; the migration of sponge into bowel lumen through an iatrogenic fistulous tract following conservative treatment of enterocutaneous fistula and a possible classification of gossypiboma into (intra-operative and post-operative) base on timing of occurrence.

Conclusion: In recognition of post-operative gossypiboma, management of enterocutaneous fistulas should be considered an extended continuation of intra-abdominal procedures.

Keywords: Gossypiboma, small bowel obstruction, post-operative fistula

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References

Alper Sozutek, Serdar Yormaz, Kupeli H, Saban B. Transgastric migration of gossypiboma remedied with endoscopic removal: A case report, BioMed Cent. 2013;6:413.

Lata I, Kapoor D, Sahu S. Gossypiboma. A rare cause of acute abdomen: A case report and review of literature. Int j Crit Illness Injury Sci. 2011;1(2):157.

Oran E, Yetkin G, Aygün N, Celayir F, Uludağ M. Intraabdominal gossypiboma: Report of two cases. Turk J Surg. 2018; 34(1):77-9.

Ryan G, kawka M, Gnananandan J, Yip V. Presentation and surgical management of a gossypiboma presenting with small bowel obstruction. Clin J Gastoenterol. 2021;14(4):1067-1070.

Kim H, Chung T-S, Suh S, Kim S. MR imaging findings of paravertebral gossypiboma. Am J Neuroradiol. 2007;28 (4):709-13.

Patial T, Thakur V, Ganesun NV, Sharma M. Gossypibomas in India-a systematic literature review. J Postgrad Med. 2017; 63(1):36.

Godara R, Marwah S, Karwasra R, Goel R, Sen J, Singh R. Spontaneous transmural migration of surgical sponges. Asian J Surg. 2006;29(1):44-5.

Tushar P, Namit R, Angesh T, Digvijay T, Kanika S. Transmigration of a retained surgical sponge: A case report. Patient Safety in Surgery. 2018;12:21.

Chopra S, Suri V, Sikka P, Aggarwal N. A case series on gossypiboma- varied clinical presentations and their management. J Clin Diagn Res. 2015;9 (12):QR01-QR3.

Sarda AK, Pandey D, Dhir U, Neogi S. Postoperative complications due to a retained surgical sponge. Singapore Med. J. 2007;48.

Erdil A, Kilciler G, Ates Y, Tuzun A, Gulsen M, Karaeren N et al. Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus, Intern. Med. (Tokyo, Japan). 2008;613.

Moffatt-Bruce SD, Cook CH, Steinberg SM, Stawicki SP. Risk factors for retained surgical items: A meta-analysis and proposed risk stratification system. J Surg Res. 2014;190(2):429-36.

Macario A, Morris D, Morris S. Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology. Arch Surg 2006;141:659- 62.

Zejnullahu VA, Bicaj BX, Zejnullahu VA et al. Retained surgical foreign bodies after surgery. Open Access Maced. J. Med. Sci. 2017;5:97-100.

Fencl JL. Guideline implementation: Prevention of retained surgical items. Aorn J. 2016;104:37-48.