Detection of a Gossypiboma
Detection of a Gossypiboma
The clinical management of an RSS depends on its location. The risk of removal must be weighed against the risk of leaving the item in place. Surgical sponges have been inadvertently left in every body cavity. Removal from the abdominal cavity, chest, or pelvis usually requires a return to the operating room, given the risk of clinical consequences.
Symptomatic patients should be offered removal of the RSS after it is recognized. The possibility of erosion and migration, as well as the anatomical location of the retained material and proximity to vital organs and vasculature, should also guide the decision for removal. In cases where the patient is asymptomatic and the sponge is detected by chance, surgical removal should be recommended after the patient has been informed about the possible complications of the retained sponge.
RSSs are usually removed by open surgery; in selected cases, minimally invasive techniques (endoscopy and laparoscopy) may be used. Endoscopy may be useful when the RSS has migrated within the lumen of a hollow organ accessible by endoscopy (such as the stomach). Laparoscopy for RSS is rarely performed, since the RSS is usually large and hard and has caused extensive adhesions or intensive granuloma formation.
The time between initial surgical operation and diagnosis of the RSS has clinical importance. When the RSS is discovered and removed during the immediate postoperative period, no demonstrable short- or long-term clinical harm results, and postoperative morbidity and mortality are extremely low. In contrast, when diagnosis is delayed, an intense inflammatory reaction may ensue, and the risk of local complications is higher; major and difficult surgical intervention may be needed, thereby increasing morbidity and even mortality rates.
Management of Clinical Consequences
The clinical management of an RSS depends on its location. The risk of removal must be weighed against the risk of leaving the item in place. Surgical sponges have been inadvertently left in every body cavity. Removal from the abdominal cavity, chest, or pelvis usually requires a return to the operating room, given the risk of clinical consequences.
Symptomatic patients should be offered removal of the RSS after it is recognized. The possibility of erosion and migration, as well as the anatomical location of the retained material and proximity to vital organs and vasculature, should also guide the decision for removal. In cases where the patient is asymptomatic and the sponge is detected by chance, surgical removal should be recommended after the patient has been informed about the possible complications of the retained sponge.
RSSs are usually removed by open surgery; in selected cases, minimally invasive techniques (endoscopy and laparoscopy) may be used. Endoscopy may be useful when the RSS has migrated within the lumen of a hollow organ accessible by endoscopy (such as the stomach). Laparoscopy for RSS is rarely performed, since the RSS is usually large and hard and has caused extensive adhesions or intensive granuloma formation.
The time between initial surgical operation and diagnosis of the RSS has clinical importance. When the RSS is discovered and removed during the immediate postoperative period, no demonstrable short- or long-term clinical harm results, and postoperative morbidity and mortality are extremely low. In contrast, when diagnosis is delayed, an intense inflammatory reaction may ensue, and the risk of local complications is higher; major and difficult surgical intervention may be needed, thereby increasing morbidity and even mortality rates.
