Skip to main content

Advertisement

SpringerLink
Log in

Retained surgical sponges: what the practicing clinician should know

  • Overview
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

RSS:

Retained surgical sponges

References

  1. Wilson C (1884) Foreign bodies left in the abdomen after laparotomy. Gynecol Tr 9:109–112

    Google Scholar 

  2. Crossen HS, Crossen DF (1940) Foreign bodies left in the abdomen. CV Mosby Co, St Louis (Mo)

    Google Scholar 

  3. Hyslop JW, Maull KI (1982) Natural history of the retained surgical sponge. South Med J 75:657–660

    CAS  PubMed  Google Scholar 

  4. Cima RR, Kollengode A, Garnatz J et al (2008) Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg 207:80–87

    Article  PubMed  Google Scholar 

  5. Gawande AA, Studdert DM, Orav EJ et al (2003) Risk factors for retained instruments and sponges after surgery. N Engl J Med 348:229–235

    Article  PubMed  Google Scholar 

  6. Rappaport W, Haynes K (1990) The retained surgical sponge following intra-abdominal surgery. Arch Surg 125:405–407

    CAS  PubMed  Google Scholar 

  7. Yildirim S, Tarim A, Nursal TZ et al (2006) Retained surgical sponge (gossypiboma) after intraabdominal or retroperitoneal surgery: 14 cases treated at a single center. Langenbecks Arch Surg 391:390–395

    Article  PubMed  Google Scholar 

  8. Yamamura N, Nakajima K, Takahashi T et al (2008) Intra-abdominal textiloma. A retained surgical sponge mimicking a gastric gastrointestinal stromal tumor. Surg Today 38:552–554

    Article  PubMed  Google Scholar 

  9. Apter S, Hertz M, Rubinstein ZJ et al (1990) Gossypiboma in the early postoperative period: a diagnostic problem. Clin Radiol 42:128–129

    Article  CAS  PubMed  Google Scholar 

  10. Botet del Castillo FX, Lopez S, Reyes G et al (1995) Diagnosis of retained abdominal gauze swabs. Br J Surg 82:227–228

    Article  CAS  PubMed  Google Scholar 

  11. Lincourt AE, Harrell A, Cristiano J et al (2007) Retained foreign bodies after surgery. J Surg Res 138:170–174

    Article  PubMed  Google Scholar 

  12. Bani-Hani KE, Gharaibeh KA, Yaghan RJ (2005) Retained surgical sponges (gossypiboma). Asian J Surg 28:109–115

    Article  PubMed  Google Scholar 

  13. Kaiser CW, Friedman S, Spurling KP et al (1996) The retained surgical sponge. Ann Surg 224:79–84

    Article  CAS  PubMed  Google Scholar 

  14. Mouhsine E, Halic N, Garofalo R et al (2005) Soft-tissue textiloma: a potential diagnostic piftall. Can J Surg 48:495–496

    PubMed  Google Scholar 

  15. McLeod RS, Bohnen JMA, Members of the CAGS (2004) Risk factors for retained foreign bodies after surgery. Can J Surg 47:57–59

    PubMed  Google Scholar 

  16. Gibbs VC (2005) Patient safety practices in the operating room: correct-site surgery and nothing left behind. Surg Clin N Am 85:1307–1319

    Article  PubMed  Google Scholar 

  17. Helmich RL (2000) On error management: lessons from aviation. BMJ 320:781–785

    Article  Google Scholar 

  18. Einstein GO, McDaniel MA, Williford CL et al (2003) Forgetting of intentions in demanding situations is rapid. J Exp Psychol Appl 9:147–162

    Article  PubMed  Google Scholar 

  19. Gonzales-Ojeda A, Rodriguez-Alcantar DA, Arenas-Marquez H et al (1999) Retained foreign bodies following intra-abdominal surgery. Hepatogastroenterology 46:808–812

    Google Scholar 

  20. Lauwers PR, Hee RHW (2000) Intraperitoneal gossypiboma: the need to count sponges. World J Surg 24:521–527

    Article  CAS  PubMed  Google Scholar 

  21. Sturdy JH, Baird RM, Gerein AN (1967) Surgical sponges: a cause of granuloma and adhesion formation. Ann Surg 165:128–134

    Article  CAS  PubMed  Google Scholar 

  22. Godara R, Marwah S, Karwasra RK et al (2006) Spontaneous transmural migration of surgical sponges. Asian J Surg 29:44–45

    Article  PubMed  Google Scholar 

  23. Sahin-Akyar G, Yagci C, Aytac S (1997) Pseudotumor due to surgical sponge: gossypiboma. Australas Radiol 41:288–291

    Article  CAS  PubMed  Google Scholar 

  24. Cevik I, Dillioglugil O, Ozveri H, Akdas A (2008) Asymptomatic retained surgical gauze towl diagnosed 32 years after nephrectomy. Int Urol Nephrol 40:885–888

    Article  PubMed  Google Scholar 

  25. Cokelaere K, Vanvuchelen J, Michielsen P et al (2001) Epithelioid angiosarcoma of the splenic capsule. Report of a case reiterating the concept of inert foreign body tumorigenesis. Virchows Arch 438:398–403

    Article  CAS  PubMed  Google Scholar 

  26. Gencosmanoglu R, Inceoglu R (2003) An unusual cause of small bowel obstruction: gossypiboma. BMC Surg 3:6

    Article  PubMed  Google Scholar 

  27. Dharamsi RD, Jesudason SRB, Rolston DDK (1990) Chronic watery diarrhea due to a surgical pack in the ileal lumen. J Clin Gastroenterol 12:239–241

    Article  CAS  PubMed  Google Scholar 

  28. Risher WH, McKinnon WM (1991) Foreign body in the gastrointestinal tract: intraluminal migration of laparotomy sponge. South Med J 84:1042–1045

    CAS  PubMed  Google Scholar 

  29. Lourenco SC, Baptista A, Pacheco H, Malhado J (2008) A misplaced surgical towel-a rare cause of fever of unknown origin. Eur J Intern Med 19:377–378

    Article  PubMed  Google Scholar 

  30. Mentes BB, Yilmaz E, Sen M et al (1997) Transgastric migration of a surgical sponge. J Clin Gastroenterol 24:55–57

    Article  CAS  PubMed  Google Scholar 

  31. Alis H, Soylu A, Dolay K et al (2007) Surgical intervention may not always be required in gossypiboma with intraluminal migration. World J Gastroenterol 13:6605–6607

    Article  CAS  PubMed  Google Scholar 

  32. Lin TY, Chuang CK, Wong YC et al (1999) Gossypiboma: migration of retained surgical gauze and spontaneous transurethral protrusion. BJU Int 84:879–880

    Article  CAS  PubMed  Google Scholar 

  33. Yaycioglu O, Ulusan S, Ezer A et al (2007) Uretoreoappendiceal fistula due to gossypiboma. Urol Int 79:187–188

    Article  PubMed  Google Scholar 

  34. Silva CS, Caetano MR, Silva EA et al (2001) Complete migration of retained surgical sponge into ileum without sign of open intestinal wall. Arch Gynecol Obstet 265:103–104

    Article  CAS  PubMed  Google Scholar 

  35. Serra J, Matias-Guiu X, Calabuig R et al (1988) Surgical gauze pseudotumor. Am J Surg 155:235–237

    Article  CAS  PubMed  Google Scholar 

  36. Richards WO, Keramati B, Scovill WA (1986) Fate of retained foreign bodies in the peritoneal cavity. South Med J 79:496–498

    CAS  PubMed  Google Scholar 

  37. Imren Y, Tasoglu I, Ozkose Z (2006) A different intracardiac mass: retained sponge. Echocardiography 23:322–323

    Article  PubMed  Google Scholar 

  38. Olnick HM, Weens HS, Rogers JV (1955) Radiological diagnosis of retained surgical sponges. JAMA 159:1525–1527

    CAS  Google Scholar 

  39. Arpit N, Abhijit R, Narlawar RS, et al. Gauze pad in the abdomen : can you give the diagnosis without knowing the history ?. J Radiol (http://www.jradiology.com/arts/50.pdf)

  40. Prasad S, Krithnan A, Limdi J, Patankar T (1999) Imaging features of gossypiboma: report of two cases. J Postgrad Med 45:18–19

    CAS  PubMed  Google Scholar 

  41. Granetzny A, Holtbecker N, Thomas H et al (2008) Misinterpretation of a pulmonary GI anastomosis stapler line as a retained foreing body. Chest 133:281–283

    Article  PubMed  Google Scholar 

  42. Choi BI, Kim SH, Yu ES et al (1988) Retained surgical sponge: diagnosis with CT and sonography. AJR Am J Roentgenol 150:1047–1050

    CAS  PubMed  Google Scholar 

  43. Revesz G, Siddiqi TS, Buchheit WA et al (1983) Detection of retained surgical sponges. Radiology 149:411–413

    CAS  PubMed  Google Scholar 

  44. Sugano S, Suzuki T, Linuma M et al (1993) Gossypiboma: diagnosis with ultrasonography. J Clin Ultrasound 21:289–292

    Article  CAS  PubMed  Google Scholar 

  45. Chau WK, Lai KH, Lo KJ (1984) Sonographic findings of intraabdominal foreign bodies due to retained gauze. Gastrointest Radiol 9:61–63

    Article  CAS  PubMed  Google Scholar 

  46. Cheng TC, Chou AS, Jeng CM et al (2007) Computed tomography findings of gossypiboma. J Chin Med Assoc 70:565–569

    Article  PubMed  Google Scholar 

  47. Parienty RA, Pradel J, Lepreux JF et al (1981) Computed tomography of sponges retained after laparotomy. J Comput Assist Tomogr 5:187–189

    Article  CAS  PubMed  Google Scholar 

  48. Kalovidouris A, Kehagias D, Moulopoulos L, Gouliamos A, Pentea S, Vlachos L (1999) Abdominal retained surgical sponges: CT appearance. Eur Radiol 9:1407–1410

    Article  CAS  PubMed  Google Scholar 

  49. Kopka L, Fischer U, Gross A et al (1996) CT of retained surgical sponges (textilomas): pitfalls in detection and evaluation. J Comput Assist Tomogr 20:919–923

    Article  CAS  PubMed  Google Scholar 

  50. Sheehan RE, Sheppard MN, Hansell DM (2000) Retained intrathoracic surgical swab: CT appearance. J Thorac Imaging 15:61–64

    Article  CAS  PubMed  Google Scholar 

  51. Sugimura H, Tamura S, Kakitsubata Y et al (1992) Magnetic resonance imaging of retained surgical sponge. Clin Imaging 16:259–262

    Article  CAS  PubMed  Google Scholar 

  52. Kim CK, Park BK, Ha H (2007) Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J Roentgenol 189:814–817

    Article  PubMed  Google Scholar 

  53. Dux M, Ganten M, Lubienski A et al (2002) Retained surgical sponge with migration into the duodenum and persistent duodenal fistula. Eur Radiol 12:74–77

    Article  Google Scholar 

  54. Ghersin E, Keidar Z, Brook OR et al (2004) A new pitfall on abdominal PET/CT: a retained surgical sponge. J Comput Assist Tomogr 28:839–841

    Article  PubMed  Google Scholar 

  55. Jain M, Sawhney S (1995) Gossypiboma: ultrasound-guided removal. J Clin Ultrasound 23:321–323

    Article  CAS  PubMed  Google Scholar 

  56. Uranus U, Schauer C, Pfeifer J et al (1995) Laparoscopic removal of a large laparotomy pad forgotten in situ. Surg Laparosc Endosc 5:77–79

    CAS  PubMed  Google Scholar 

  57. Erdil A, Kilciler G, Ates Y et al (2008) Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus. Inter Med 47:613–615

    Article  Google Scholar 

  58. Singh R, Mathur RK, Patidar S et al (2004) Gossypiboma: its laparoscopic diagnosis and removal. Surg Laparosc Endosc Percutan Tech 14:304–305

    Article  PubMed  Google Scholar 

  59. Pierson MA (1995) Patient and environment safety. In: Mecker M, Rothrock J (eds) Alexander’s care of the patient in surgery, 10th edn. Mosby-Year Book, St Louis, pp 19–34

    Google Scholar 

  60. AORN Recommended Practices Committee (2006) Recommended practices for sponge, sharps, and instruments counts. AORN J 433:412–418

    Google Scholar 

  61. Sarr MG (2005) Retained foreign bodies—why do we still allow them to occur? Surgery 137:304–305

    Article  PubMed  Google Scholar 

  62. Dossett LA, Dittus RS, Speroff T et al (2008) Cost-effectiveness of routine radiographs after emergent open cavity operations. Surgery 144:317–321

    Article  PubMed  Google Scholar 

  63. Macario A, Morris D, Morris S (2006) Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology. Arch Surg 141:659–662

    Article  PubMed  Google Scholar 

  64. Rogers A, Jones E, Oleynikov D (2007) Radiofrequency identification (RFID) applied to surgical sponges. Surg Endosc 21:1235–1237

    Article  CAS  PubMed  Google Scholar 

  65. Fabian CE (2005) Electronic tagging of surgical sponges to prevent their accidental retention. Surgery 137:298–301

    Article  PubMed  Google Scholar 

Download references

Author contributions

The contributions of the authors are as follows: study conception and design, George H. Sakorafas; acquisition of data, Dimitrios Sampanis, Christos Lappas, Eva Papantoni; analysis and interpretation of data, George Sakorafas, Spyros Christodoulou, Aikaterini Mastoraki, Michael Safioleas; and drafting of the manuscript, George Sakorafas.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. 4th Department of Surgery, Athens University, Medical School, ATTIKON U. Hospital, Arkadias 19-21, 115 26, Athens, Greece

    George H. Sakorafas, Dimitrios Sampanis, Christos Lappas, Eva Papantoni, Spyros Christodoulou, Aikaterini Mastoraki & Michael Safioleas

Authors
  1. George H. Sakorafas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Sampanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christos Lappas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eva Papantoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Spyros Christodoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aikaterini Mastoraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Safioleas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George H. Sakorafas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sakorafas, G.H., Sampanis, D., Lappas, C. et al. Retained surgical sponges: what the practicing clinician should know. Langenbecks Arch Surg 395, 1001–1007 (2010). https://doi.org/10.1007/s00423-010-0684-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0684-4

Keywords

Search

Navigation