Reducing the risk of gossypiboma and other retained items during surgery
Abstract
A surprising number of foreign bodies may be inadvertently left in tissues after surgery, including suture material, needles, surgical instruments, starch powder from gloves, fragments of lint and gauze swabs. In particular, the problem of the retained gauze swab is well recognised in human surgery, perhaps not surprisingly as there are so many used in each procedure. The inflammatory reaction to a retained gauze swab is called gossypiboma — from the Latin word gossypium in reference to the cotton fibres of the swab and the Swahili word boma meaning ‘place of concealment’. Gossypibomas occur because there is a failure to account for all the swabs used during a surgical procedure. Depending on the proximity to vital structures and the degree of associated inflammation and infection, the consequences of a retained surgical swab can range from abscess or fistula formation to life-threatening septicaemia or tumour formation. The veterinary nurse assisting in theatre has a vital role to play in minimising the incidence of retained items via surgical counting, good trolley management and effective communication.
The local tissue response to the cellulose fibres in a retained surgical swab is inflammatory, commonly resulting in aseptic granulomatous encapsulation that may be apparent clinically as a palpable mass (Merlo and Lamb, 2000). The mass formed can have a similar effect on patient health to that of a tumour (Sakayama et al, 2005), both in appearance by diagnostic imaging and initially during surgical exploration. If histopathology is not performed on the mass, this may result in the misdiagnosis of a patient, with potential serious consequences.
The proximity of a gossypiboma to vital structures is significant as invasion of adjacent viscera represents another possible serious consequence of the foreign body reaction that surrounds the swab. Intra-abdominal gossypibomas have been reported as migrating into the ileum, stomach, colon or bladder resulting in obstruction (Wattanasirichaigoon, 1996) and even visceral perforation (Lata et al. 2011). Significant tissue erosion can occur from the fibrous material of the swab, either directly leading to sinus or fistula formation, or indirectly by stimulation of the growth of adhesions post surgery (Jones, 2008).
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