Gossypiboma is the medical term for a mass of cotton material, most commonly a surgical sponge, unintentionally left inside a patient’s body following surgery. This condition represents a type of retained surgical item (RSI), a rare but serious complication. The term is derived from “gossypium,” Latin for cotton, and “boma,” a Swahili word meaning a place of concealment, reflecting the nature of this hidden foreign object.
Formation and Risk Factors
Gossypibomas typically arise from human error during surgical procedures. Several factors increase this risk. Emergency operations, often involving increased urgency and less structured environments, elevate the likelihood. Unexpected changes in surgical plans or prolonged, complex procedures also elevate the risk, as these situations can disrupt routine protocols.
Other factors include operations with a large number of sponges or those performed on patients with a high body mass index. Inadequate or hurried sponge counts and changes in the surgical team can lead to miscounts. While the abdominal cavity is the most frequent site, gossypibomas can occur in nearly any body cavity.
Clinical Presentation and Symptoms
The body reacts to a gossypiboma in two primary ways, influencing symptom manifestation. An acute (exudative) reaction occurs relatively soon after surgery, often within days or weeks. This reaction involves inflammation and may lead to bacterial contamination, presenting with symptoms such as fever, localized pain, abscess formation, purulent discharge, or a draining sinus.
A chronic (aseptic) reaction develops over a longer period, sometimes remaining asymptomatic for months or years. Here, the body attempts to wall off the foreign object by forming fibrous tissue, leading to adhesions and encapsulation. This can result in a painless, palpable mass, or cause vague, chronic symptoms like abdominal discomfort, nausea, vomiting, or altered bowel habits.
Diagnosis and Treatment
Diagnosing a gossypiboma often involves various imaging techniques, given its varied, non-specific symptoms. Surgical sponges are manufactured with radiopaque markers, visible on plain X-rays, aiding detection. A computed tomography (CT) scan is typically the most definitive diagnostic tool, revealing a characteristic spongiform appearance with gas bubbles or calcifications.
Ultrasound can also be employed, showing an echogenic mass with posterior acoustic shadowing. Once identified, standard treatment involves surgical removal of the retained object. During this procedure, the surgeon addresses any associated complications, such as draining an abscess or repairing damaged tissue. Minimally invasive techniques like laparoscopy or endoscopy may be used for removal, depending on the object’s location and size.
Health Complications
If a gossypiboma remains undiagnosed and untreated, it can lead to severe complications. Prolonged presence of the foreign body can result in widespread infection, known as sepsis. The inflammatory reaction can also cause the sponge to erode through adjacent organ walls, leading to conditions like bowel or visceral perforation.
Another complication is the formation of a fistula, which is an abnormal connection between two organs or an organ and the skin. In some instances, the retained sponge can also migrate into the lumen of hollow organs like the bowel, potentially causing intestinal obstruction. These severe outcomes highlight the importance of timely diagnosis and intervention.