Gossypibomas in India - A systematic literature review

Abstract

Purpose of Review:Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature.Materials and Methods:A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India.Results:On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%).Conclusions:Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.

Intravesical gossypiboma: our experience and the need for stringent checklist and training!

“…Presence of multiple nursing teams (more than two) in the theatre is also implicated for 80% of count discrepancies. Surgical procedures that are performed late (excluding procedures performed as emergency) or on weekends and holidays carrying a greater risk of gossypiboma 9–11…”

“…The most common cause was found to be gynaecological surgery (41.2%), abdominal surgery (35.7%), urological surgery, orthopaedic surgery, neurosurgery, cardiothoracic and vascular surgeries and thyroid surgery. The most common location was found to be abdomen (51.5%), followed by pelvis (28.57%) 9. Urinary bladder gossypiboma can manifest any time from the immediate postoperative period to late presentation ranging up to 6 years 8.…”

“…Gossypiboma is an avoidable condition that unnecessarily increases the morbidity and mortality of the patient. This is often referred to as ‘Res Ipsa Loquitur’ meaning ‘the thing speaks for itself,’ and that the issue at hand would not have happened if there was no negligence on the part of the surgeon 9…”

Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula

“…Migration of the gossypiboma is a rare feature. The patient usually presents late 21 25Exudative response—generated by a gossypiboma of high antigenicity, eliciting a more severe inflammatory response leading to formation of abscess.…”

“…A fold of the sponge may enter the lumen and with the help of continuous bowel peristalsis, the complete mop can enter the lumen and can even migrate distally into the bowel. Eventually, the migrating gossypiboma might get stuck somewhere distally in the small bowel or at the ileo-caecal junction leading to intestinal obstruction 25 26. In rare instances, the gossypiboma may negotiate beyond the ileo-caecal junction and be evacuated by defecation 27…”