An article appearing on February 22, 2018 in The New England Journal of Medicine discussed the case of a 42-year-old Japanese woman who had been experiencing lower abdominal bloating for three years. The woman went to her primary care provider for diagnosis where abdominal palpation found two nontender masses in her right and left iliac fossae (the large, smooth concave surface on the internal surface of the ilium, which is part of the three fused bones that make up the hip bone).
The primary care provider ordered radiology studies that showed hyperdense, serpiginous (i.e., having a wavy border), symmetric lesions. An abdominal CT scan revealed well-defined, stringy structures, which led to the decision to perform a laparotomy (a large surgical incision through the abdominal wall to access the abdominal cavity). During the surgery, two smooth masses were found that were partially adhered to the greater omentum (a membranous double layer of fatty tissue that covers and supports the intestines and organs located in the lower abdomen) and to the colon.
The two masses were surgical removed and then divided in half. The masses contained gauze sponges encapsulated by thick, fibrous walls. Radiopaque barium sulfate strands were also observed. The diagnosis was “gossypiboma.”
The woman had undergone two cesarean section deliveries six and nine years prior, which were the only abdominal surgical procedures she previously had. Therefore, it was determined that the two surgical sponges had to have been left inside of her for at least six years. Once the two masses were removed, the woman’s lower abdominal bloating resolved. She spent five days in the hospital following the surgery.
Gossypiboma
The word “gossypiboma” is derived from the Latin word “gossypium,” which means cotton, and the Swahili word “boma,” which means place of concealment.
A gossypiboma is a foreign object, such as a sponge, that is left behind in a body cavity during surgery. It is also called textiloma or cottonoid. Frequent sites for the formation of gossypibomas include the thoracic cavity, the pleural cavity, the pericardial cavity, and the abdominal cavity. Gossypibomas are most frequently discovered in the abdomen.
Gossypibomas cause two types of responses in the body: exudative gossypibomas that usually occur early in the postoperative period and may involve secondary bacterial contamination that can result in various fistulas, and aseptic gossypibomas that can have adhesions, encapsulation, and eventually result in granuloma formation.
A possible complication of a retained surgical sponge is the development of an angiosarcoma (cancer of the inner lining of blood vessels).
If you may have been injured as a result of a foreign object, such as a retained sponge, left behind during a medical procedure in the United States, you should promptly consult with a medical malpractice attorney in your state who may investigate your foreign object medical malpractice claim for you and represent you in a foreign object medical malpractice case, if appropriate.
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