Limits...
Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature.

Srivastava KN, Agarwal A - Case Rep Surg (2014)

Bottom Line: It can even remain silent and present years after the operation.She had a history of cesarean section 4 years ago.Radiological investigations were inconclusive in detecting the retained sponge.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Minimal Access Surgery, B. L. Kapur Super Speciality Hospital, Pusa Road, New Delhi 110005, India.

ABSTRACT
The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 38-year-old lady who presented with vague pain and chronic lump in the right iliac fossa region. She had a history of cesarean section 4 years ago. Radiological investigations were inconclusive in detecting the retained sponge. A working diagnosis of mesenteric cyst was made and an exploratory laparotomy was done where she was found to have a large gossypiboma densely adhered to the small bowel and surrounding structures. Though rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain or chronic lump even years after the operation.

No MeSH data available.


Related in: MedlinePlus

CECT image revealing the cyst in relation to the bowel.
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fig1: CECT image revealing the cyst in relation to the bowel.

Mentions: A 38-year-old lady presented to our surgical clinics with the complaints of pain and lump right side lower abdomen 3 years ago. She had a history of emergency caesarean section done in a different country 4 years back. The patient had some discomfort at the right iliac fossa region in the postoperative phase which was explained to the patient as postoperative pain. No further advanced investigations were carried out at that stage. Following this the patient started to notice a lump formation at the site of the discomfort in the right iliac fossa region. The lump was gradually progressive in nature and the pain associated with the lump also gradually increased in intensity. The patient underwent an ultrasound and a CECT abdomen (Figure 1) before consulting us. Both these tests revealed a well-defined lump in relation to the small bowel in the right iliac fossa region suggestive of mesenteric cyst. On clinical examination there was a large lump in the right iliac fossa region of 20 cm × 15 cm. An MRI scan of the abdomen was conducted to ascertain the exact nature of the mass. The MRI was also inconclusive in making a definitive diagnosis and it revealed a cystic mass in relation to the bowel with a thick membrane inside the mass. A differential diagnosis of hydatid cyst was suggested upon the MRI.


Gossypiboma posing as a diagnostic dilemma: a case report and review of the literature.

Srivastava KN, Agarwal A - Case Rep Surg (2014)

CECT image revealing the cyst in relation to the bowel.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279710&req=5

fig1: CECT image revealing the cyst in relation to the bowel.
Mentions: A 38-year-old lady presented to our surgical clinics with the complaints of pain and lump right side lower abdomen 3 years ago. She had a history of emergency caesarean section done in a different country 4 years back. The patient had some discomfort at the right iliac fossa region in the postoperative phase which was explained to the patient as postoperative pain. No further advanced investigations were carried out at that stage. Following this the patient started to notice a lump formation at the site of the discomfort in the right iliac fossa region. The lump was gradually progressive in nature and the pain associated with the lump also gradually increased in intensity. The patient underwent an ultrasound and a CECT abdomen (Figure 1) before consulting us. Both these tests revealed a well-defined lump in relation to the small bowel in the right iliac fossa region suggestive of mesenteric cyst. On clinical examination there was a large lump in the right iliac fossa region of 20 cm × 15 cm. An MRI scan of the abdomen was conducted to ascertain the exact nature of the mass. The MRI was also inconclusive in making a definitive diagnosis and it revealed a cystic mass in relation to the bowel with a thick membrane inside the mass. A differential diagnosis of hydatid cyst was suggested upon the MRI.

Bottom Line: It can even remain silent and present years after the operation.She had a history of cesarean section 4 years ago.Radiological investigations were inconclusive in detecting the retained sponge.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Minimal Access Surgery, B. L. Kapur Super Speciality Hospital, Pusa Road, New Delhi 110005, India.

ABSTRACT
The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 38-year-old lady who presented with vague pain and chronic lump in the right iliac fossa region. She had a history of cesarean section 4 years ago. Radiological investigations were inconclusive in detecting the retained sponge. A working diagnosis of mesenteric cyst was made and an exploratory laparotomy was done where she was found to have a large gossypiboma densely adhered to the small bowel and surrounding structures. Though rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain or chronic lump even years after the operation.

No MeSH data available.


Related in: MedlinePlus