Retained surgical sponge following abdominal surgery

OBJECTIVE: To share the experience of gossypiboma cases, their presenting features, preoperative risk factors and post-operative outcome in terms of complications and recovery. STUDY DESIGN: Retrospective study. PLACE AND DURATION OF STUDY: Several government and private hospitals of Karachi, over an operative experience exceeding 35 years for the principal author and 15 years for the co-authors. PATIENT AND METHOD: This study includes collective personal operative experience with patients having gossypibomas. It is compiled by two general surgeons and one gynecologist. Data of 14 cases with primary diagnosis of gossypiboma were reviewed and analyzed. Literature was searched for relevant information. RESULT: There were 11 female and 3 male patients. Mean age of the patients was 42 years (range 25 to 59 years). Cesarean section was the commonest surgery performed in 5 patients followed by hysterectomies in 3 patients. Plain radiograph and CT scan abdomen were found to be helpful in diagnosis. Mean interval between initial and final surgeries was eight months (range one week to two years). All patients recovered completely after surgical removal of gossypiboma. CONCLUSION: Retained sponge was more common in obstetrical procedures performed in emergency. Presence of abdominal mass or intestinal obstruction was the commonest presentation (93%). Micro-air-bubbles in plain abdominal x-ray in a post laparotomy patient appeared to be a diagnostic feature of gossypiboma. CT scan was better than other radiological investigations in identifying the retained sponge.