Transmural Migration of Retained Surgical Sponges

Abstract

Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports a case in which a retained surgical sponge eroded from the intra-abdominal space into the intestinal lumen, migrated distally, and spontaneously passed with defecation 12 weeks after the cesarean section. We performed a systematic review of the literature in Pubmed and found 64 cases of transmural migration of retained surgical sponges. Sixty-four cases have been reported of transmural migration, mainly after intra-abdominal surgery. The most frequent site of impaction is the intestine (75%), but we also found 2 cases that describe migration into the stomach and 7 into the bladder. Five more cases have been published describing transdiaphragmic migration. Only 4 cases describe a sponge spontaneously expelled through the rectum, whereas more than 93% needed re-intervention. We strongly advise only the use sponges with radiopaque markers during surgery and additional methodical wound/body cavity examination.

Gossypiboma: Retained Surgical Sponge After Total Abdominal Hysterectomy with Spontaneous Transurethral Partial Extrusion

“…A review of 64 cases of transmural migration of retained surgical sponges, mainly after intra-abdominal surgery, showed that 75% of the cases involved intestinal migration, whereas only 7 cases described migration into the bladder [6]. Spontaneous transurethral protrusion is rare, and the present authors have the knowledge of the report of only one case [8].…”

“…Retained surgical sponges have been reported to occur after a diversity of surgical procedures such as abdominal, thoracic, cardiovascular, orthopaedic, and even neurosurgical operations [2,6]. Following retention, they have revealed themselves as intra-abdominal masses, in intestinal fistulae, by intestinal obstruction after transmural migration into the intestinal lumen, by protrusion into the gastric antrum from the first part of the duodenum, and into the rectum.3 Most cases present as a mass or with subacute intestinal obstruction, although rarely do they result in fistulas, free perforation or even extrusion [7].…”

“…Suggestions put forward to prevent retention of surgical sponges as well as facilitate early postoperative detection include use of sponges with counting of surgical materials once at the beginning and twice at the end of the surgery, methodical wound/body cavity examination and use of sponges with radiopaque markers, and the routine radiographic screening of high-risk patients before they leave the operating room even when counts are documented as correct [2,4,6]. The most important consideration is for the surgeon to keep in mind that despite correct sponge counts gossypibomas do occur and it is responsibility to prevent.…”

Textiloma: A Case Report of Rectal Expulsion

“…Migration of textiloma in the intestinal lumen is considered a rare complication and occurs as a result of inflammation of the intestinal wall leading to necrosis [1]. Few cases have been reported in the literature: a case involving intestinal lumen migration recorded in Japan [8] with Zantvoord et al [1] noting 65 cases in total including one of theirs.…”

“…Unfortunately, it often leads to additional and repeated surgery hence associated with higher rates of morbidity and mortality. On the other hand, there are very few cases relating to spontaneous rectal expulsion of textiloma or other retained surgical foreign bodies [1]. Thus we hereby report a case of textiloma expelled in faeces in a 26-year-old female with previous medical history of Csection for dynamic dystocia a year prior to her admission.…”