Gossypiboma: A Preventable Surgical Complication

What is Gossypiboma?

Gossypiboma refers to a retained surgical sponge, gauze, or textile inside a patient’s body after surgery. It is a rare but serious complication that can lead to severe morbidity and even mortality.

The term “Gossypiboma” originates from:

? Gossypium (Latin for cotton)

? Boma (Swahili for place of concealment)

How Does Gossypiboma Occur?

Despite strict surgical protocols, retained surgical items (RSIs) occur due to:

? Emergency or high-blood-loss surgeries

? Inadequate surgical counts

? Multiple teams handling the case

? Large incisions or deep cavities (e.g., abdomen, pelvis, thorax)

What Happens if a Sponge is Left Behind?

Gossypibomas can trigger two types of reactions in the body:

1. Exudative (Acute) – Leads to infection, abscess, and sepsis.

2. Fibrotic (Chronic) – Causes mass formation, adhesions, bowel obstruction, or even fistula formation.

Clinical Presentation

Symptoms can appear immediately or even years later, making diagnosis challenging.

?? Early Symptoms (Days to Weeks)

? Severe abdominal pain

? Fever & infection

? Vomiting & distension

? Wound infection or dehiscence

?? Late Symptoms (Months to Years)

? Unexplained abdominal mass

? Chronic pain

? Fistula formation (abnormal connections between organs)

? Bowel obstruction

Diagnosis of Gossypiboma

?? Imaging is the key!

? X-ray – Can detect sponges with radio-opaque markers

? Ultrasound – Shows a cystic mass

? CT Scan – Best for detecting foreign body granulomas

? MRI – Helps differentiate gossypiboma from tumors

Complications of Gossypiboma

?? Sepsis & multi-organ failure

?? Adhesions & chronic inflammation

?? Intestinal obstruction or perforation

?? Fistula formation (enterocutaneous, colovesical, etc.)

?? Increased legal & medical liability for hospitals

Prevention: How Can We Avoid This?

? Strict sponge & instrument counting before & after surgery

? Use of radio-opaque sponges for easy detection

? Surgeon’s final cavity sweep before closure

? Technology-driven solutions like RFID or barcode scanning of sponges

? Improved OR teamwork & communication

Take-Home Message

?? Gossypiboma is preventable but remains a real challenge in surgery.

?? Strict adherence to surgical safety protocols can prevent RSIs.

?? Early detection through imaging can reduce complications.

?? Have you ever encountered a case of Gossypiboma? Let’s discuss in the comments!

By Author

Dr. Danish Kaif

M.B.B.S , MS General Surgery, FIAGES

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