Summary Gossypiboma – the retained surgical swab: An enduring clinical challenge
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Gossypiboma – the retained surgical swab
Instelling
University Of The People
Retained abdominal swabs remain a difficult problem. This review highlights the risk factors and index pathology, as well as markers
that raise clinical suspicion, of a condition that may be elusive in presentation on account of its otherwise nonspecific signs and
symptom
Gossypiboma – the retained surgical swab: An enduring clinical
challenge
R Naidoo, FCS (SA), MMed (Surgery); B Singh, FCS (SA), MD
Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Corresponding author: R Naidoo (ruvashni@gmail.com)
Retained abdominal swabs remain a difficult problem. This review highlights the risk factors and index pathology, as well as markers
that raise clinical suspicion, of a condition that may be elusive in presentation on account of its otherwise nonspecific signs and
symptoms. A review of the English literature reporting retained abdominal swabs between 1992 and 2012 revealed 100 cases. Fifty-six
percent of patients presented with pain, most commonly coupled with an abdominal mass or symptoms of bowel obstruction; 6% of
patients presented with a fistula or a sinus; and 6% presented with extrusion of the swab; only 7% presented with signs indicative of
sepsis. The most common initial surgery was obstetric and gynaecological (in 44% of cases); the second most common was general
surgery (36%), most commonly following cholecystectomy. Plain abdominal X-ray was done in 45% of patients, followed by ultrasound,
computed tomography (CT) scan or both. CT scan is the best preoperative diagnostic tool currently. The varying presentations
exhibited by this postsurgical entity will continue to perplex the attendant practitioner. Clinical suspicion assisted by ultrasound and
CT scan will improve definitive diagnosis. While there are many checkpoints to prevent this rare yet significant complication, human
error and the unpredictability of surgery may make elimination impossible. The challenges presented with a retained swab, although rare,
will persist, and with it the devastating consequences for both patient and clinician. Because of this, especially in the era of a litigious
mindset, surgical vigilance and pre-emptive measures cannot be emphasised enough.
S Afr J Obstet Gynaecol 2016;22(1):29-32 DOI:10.7196/SAJOG.2016.v22i1.1052
The term ‘gossypiboma’ is used to describe
a retained surgical swab following any Literature search using keywords
surgical procedure. Although a rela undertaken using the Google
Scholar, Pubmed/Medline, EBSCO host Titles of all results were
tively rare occurrence, it has been noted research databases and Science Direct screened for relevance
since the beginning of surgical practice databases between 1990 and 2012
and continues to date, despite advances
in operative theatre practice. The con
sequences of a retained swab can be
life-altering or even fatal. The myriad of Reports of retained swabs outside the
clinical presentations often mimic other abdomen and pelvis were excluded
Patients under the age of 18 were excluded Of the relevant results, foreign-
clinical entities, making the diagnosis language publications were excluded
difficult. Non-human subjects were excluded and abstracts of relevant articles were
Studies reporting three or more cases were not evaluated for suitability
Epidemiology added to the cohort as these results were used
to compare conclusions
Accurate incidence of gossypiboma is
hampered by the reluctance to report
these cases, as well as the confidentiality
agreements following legal settlements.[1]
This complication may sometimes remain
asymptomatic, being discovered many years The number of case reports
satisfying all criteria was 95,
later or diagnosed at a different institution,
which reported 100 cases.
and these factors impact on the accuracy of Each article was then used to
its incidence. The most common retained fill in a proforma
foreign body is the surgical swab, probably
because of its frequent use, small size and Fig. 1. Search strategy and data collection methods.
being easily missed when blood soaked.[1] The
most common site involved is the abdominal
cavity followed by the thoracic cavity.[1] Data abstraction and was quantified under the following
For this review on the challenges analysis headings: clinical presentation, radiological
presented by a retained swab, the search The content from the literature was imaging, initial surgery and time between
strategy and data collection were based on reviewed by a single author to eliminate bias surgery and presentation. Descriptive data
the review of published literature (Fig. 1). in extracting information. The information analysis was conducted.
SAJOG • September 2016, Vol. 22, No. 1 29
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