Case report acute abdomen from gossypiboma: A case series and review of literature

Abstract

Gossypiboma may not be too uncommon especially in developing countries but it is definitely under-reported. It is an avoidable surgical error. The abdominal cavity is the commonest site of retained material after surgery and sponges and gauzes (Gossypiboma) the commonest material retained. Gossypiboma in abdominal cavity elicits two types of responses, of exudative response leading to abscess formation resulting in peritonitis and fibrinous response resulting in granuloma formation with possible pseudotumour effect and intestinal obstruction. Gossypiboma may lead to serious surgical condition resulting in significant morbidity and mortality. The pseudotumour effect may lead to the patient being informed of a possibility of intra-abdominal malignamy and may therefore be subjected to unnecessary invasive investigations. All these may also lead to medicolegal implications. We present two cases of gossypiboma seen in our surgical unit within two months. The pathogenesis of these cases were due to exudative responses consequent on retained large size sponges in the abdominal cavity, leading to peritonitis. Pre-operative diagnosis was not made. Plain abdominal x-rays did not show up the sponges because they were no radioopaque strips incorporated in them but showed features consistent with peritonitis and ileus. Abdomino-pelvic ultrasound was equally unhelpful as its showed only features of peritonitis. Gossypiboma should always be treated surgically. The surgeon who operates in the abdominal cavity must assume the "captain of the ship' doctrine and make sure all protocols are observed to prevent the incidence of gossypiboma. This is even more pertinent to the rural surgeon working with untrained auxiliaries in peripheral hospital where the incidence of gossypiboma and other retained instructions are commoner especially in developing countries. © 2011 EuroJournals Publishing, Inc.