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Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for
surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...
complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body.


Etymology

Gossypiboma is derived from
Latin Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...
''
gossypium ''Gossypium'' () is a genus of flowering plants in the tribe Gossypieae of the Malva, mallow family, Malvaceae, from which cotton is harvested. It is native to tropical and subtropical regions of the Old World, Old and New Worlds. There are abo ...
'' (cotton) and "-oma"(Greek combining element) meaning a tumor or growth. Gossypiboma describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma. Textiloma is derived from
textile Textile is an Hyponymy and hypernymy, umbrella term that includes various Fiber, fiber-based materials, including fibers, yarns, Staple (textiles)#Filament fiber, filaments, Thread (yarn), threads, and different types of #Fabric, fabric. ...
(surgical sponges have historically been made of cloth), 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 incidence 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 A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
s and
abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...
es, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient
morbidity A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
. Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an
abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...
may form with or without a secondary bacterial infection. The second reaction is an
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
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 (AORN). 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 The American College of Surgeons (ACS) is a professional medical association for surgeons and surgical team members, founded in 1913. It claims more than 90,000 members in 144 countries. History The ACS was founded in 1913 as an outgrowth of ...
and the
Joint Commission The Joint Commission is a United States-based nonprofit tax-exempt 501(c) organization that accredits more than 22,000 US health care organizations and programs. The international branch accredits medical services from around the world. A majori ...
. In most countries, surgical sponges contain
radiopaque Radiodensity (or radiopacity) is opacity to the radio wave and X-ray portion of the electromagnetic spectrum: that is, the relative inability of those kinds of electromagnetic radiation to pass through a particular material. Radiolucency or hypode ...
material that can be readily identified in
radiographic Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiography and "therapeu ...
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 An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...
films after surgery to reduce the likelihood of foreign body inclusion.


See also

*
Retained surgical instruments A retained surgical instrument is any item inadvertently left behind in a patient’s body in the course of surgery. There are few books about it and it is thought to be underreported.Gibbs, Verna C. “Chapter 22. The Retained Surgical Sponge.” ...


References

*{{cite journal , author=Camazine, Brian , title=The persistent problem of the retained foreign body , journal=The Journal of Family Practice , url=http://www.jfponline.com/Pages.asp?AID=2068 , access-date=2010-05-06 , archive-url=https://web.archive.org/web/20120224193542/http://www.jfponline.com/Pages.asp?AID=2068 , archive-date=2012-02-24 , url-status=dead


External links


Case description and discussion

Ohio University, Data Matrix Integrity Test

A unified system for gossypiboma prevention
Surgery