Gossypiboma
Encyclopedia
Gossypiboma or textiloma is the technical term for a surgical
complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin
gossypium (“cotton wool, cotton
”) and the Swahili
boma (place of concealment) and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. "Textiloma" is derived from textile
(surgical sponges have historically been made of cloth) and the suffix "-oma", meaning a tumor
or growth, and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.
of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations and are most frequently discovered in the abdomen. The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.
Gossypibomas can often present, clinically or radiologically, similar to tumor
s and abscess
es, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity. Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess
may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma. Symptoms may not present for long periods of time, sometimes months or years following surgery.
). Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure. Other guidelines have been promoted by the American College of Surgeons
and the Joint Commission.
In most countries, surgical sponges contain radiopaque
material that can be readily identified in radiographic and CT
images, facilitating detection. In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940. Some surgeons recommend routine postoperative X-ray
films after surgery to reduce the likelihood of foreign body inclusion.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
gossypium (“cotton wool, cotton
Cotton
Cotton is a soft, fluffy staple fiber that grows in a boll, or protective capsule, around the seeds of cotton plants of the genus Gossypium. The fiber is almost pure cellulose. The botanical purpose of cotton fiber is to aid in seed dispersal....
”) and the Swahili
Swahili language
Swahili or Kiswahili is a Bantu language spoken by various ethnic groups that inhabit several large stretches of the Mozambique Channel coastline from northern Kenya to northern Mozambique, including the Comoro Islands. It is also spoken by ethnic minority groups in Somalia...
boma (place of concealment) and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. "Textiloma" is derived from textile
Textile
A textile or cloth is a flexible woven material consisting of a network of natural or artificial fibres often referred to as thread or yarn. Yarn is produced by spinning raw fibres of wool, flax, cotton, or other material to produce long strands...
(surgical sponges have historically been made of cloth) and the suffix "-oma", meaning a tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
or growth, and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.
Incidence and clinical presentation
The actual incidenceIncidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations and are most frequently discovered in the abdomen. The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.
Gossypibomas can often present, clinically or radiologically, similar to tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s and abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
es, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity. Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma. Symptoms may not present for long periods of time, sometimes months or years following surgery.
Prevention
To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORNAORN
The Association of periOperative Registered Nurses , represents more than 41,000 registered nurses in the United States and abroad who facilitate the management, teaching and practice of perioperative nursing, or who are enrolled in nursing education or engaged in perioperative research...
). Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure. Other guidelines have been promoted by the American College of Surgeons
American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:...
and the Joint Commission.
In most countries, surgical sponges contain radiopaque
Radiodensity
Radiodensity refers to the relative inability of electromagnetic radiation, particularly X-rays, to pass through a particular material. Radiolucency indicates greater transparency or "transradiancy" to X-ray photons...
material that can be readily identified in radiographic and CT
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
images, facilitating detection. In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940. Some surgeons recommend routine postoperative X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
films after surgery to reduce the likelihood of foreign body inclusion.