Langenbeck's Archives of Surgery

, Volume 395, Issue 8, pp 1001–1007

Retained surgical sponges: what the practicing clinician should know

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


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.


Surgery Foreign bodies Retained Sponges Instruments Complications Morbidity Fistula 



Retained surgical sponges


  1. 1.
    Wilson C (1884) Foreign bodies left in the abdomen after laparotomy. Gynecol Tr 9:109–112Google Scholar
  2. 2.
    Crossen HS, Crossen DF (1940) Foreign bodies left in the abdomen. CV Mosby Co, St Louis (Mo)Google Scholar
  3. 3.
    Hyslop JW, Maull KI (1982) Natural history of the retained surgical sponge. South Med J 75:657–660PubMedGoogle Scholar
  4. 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 207:80–87CrossRefPubMedGoogle Scholar
  5. 5.
    Gawande AA, Studdert DM, Orav EJ et al (2003) Risk factors for retained instruments and sponges after surgery. N Engl J Med 348:229–235CrossRefPubMedGoogle Scholar
  6. 6.
    Rappaport W, Haynes K (1990) The retained surgical sponge following intra-abdominal surgery. Arch Surg 125:405–407PubMedGoogle Scholar
  7. 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 391:390–395CrossRefPubMedGoogle Scholar
  8. 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 38:552–554CrossRefPubMedGoogle Scholar
  9. 9.
    Apter S, Hertz M, Rubinstein ZJ et al (1990) Gossypiboma in the early postoperative period: a diagnostic problem. Clin Radiol 42:128–129CrossRefPubMedGoogle Scholar
  10. 10.
    Botet del Castillo FX, Lopez S, Reyes G et al (1995) Diagnosis of retained abdominal gauze swabs. Br J Surg 82:227–228CrossRefPubMedGoogle Scholar
  11. 11.
    Lincourt AE, Harrell A, Cristiano J et al (2007) Retained foreign bodies after surgery. J Surg Res 138:170–174CrossRefPubMedGoogle Scholar
  12. 12.
    Bani-Hani KE, Gharaibeh KA, Yaghan RJ (2005) Retained surgical sponges (gossypiboma). Asian J Surg 28:109–115CrossRefPubMedGoogle Scholar
  13. 13.
    Kaiser CW, Friedman S, Spurling KP et al (1996) The retained surgical sponge. Ann Surg 224:79–84CrossRefPubMedGoogle Scholar
  14. 14.
    Mouhsine E, Halic N, Garofalo R et al (2005) Soft-tissue textiloma: a potential diagnostic piftall. Can J Surg 48:495–496PubMedGoogle Scholar
  15. 15.
    McLeod RS, Bohnen JMA, Members of the CAGS (2004) Risk factors for retained foreign bodies after surgery. Can J Surg 47:57–59PubMedGoogle Scholar
  16. 16.
    Gibbs VC (2005) Patient safety practices in the operating room: correct-site surgery and nothing left behind. Surg Clin N Am 85:1307–1319CrossRefPubMedGoogle Scholar
  17. 17.
    Helmich RL (2000) On error management: lessons from aviation. BMJ 320:781–785CrossRefGoogle Scholar
  18. 18.
    Einstein GO, McDaniel MA, Williford CL et al (2003) Forgetting of intentions in demanding situations is rapid. J Exp Psychol Appl 9:147–162CrossRefPubMedGoogle Scholar
  19. 19.
    Gonzales-Ojeda A, Rodriguez-Alcantar DA, Arenas-Marquez H et al (1999) Retained foreign bodies following intra-abdominal surgery. Hepatogastroenterology 46:808–812Google Scholar
  20. 20.
    Lauwers PR, Hee RHW (2000) Intraperitoneal gossypiboma: the need to count sponges. World J Surg 24:521–527CrossRefPubMedGoogle Scholar
  21. 21.
    Sturdy JH, Baird RM, Gerein AN (1967) Surgical sponges: a cause of granuloma and adhesion formation. Ann Surg 165:128–134CrossRefPubMedGoogle Scholar
  22. 22.
    Godara R, Marwah S, Karwasra RK et al (2006) Spontaneous transmural migration of surgical sponges. Asian J Surg 29:44–45CrossRefPubMedGoogle Scholar
  23. 23.
    Sahin-Akyar G, Yagci C, Aytac S (1997) Pseudotumor due to surgical sponge: gossypiboma. Australas Radiol 41:288–291CrossRefPubMedGoogle Scholar
  24. 24.
    Cevik I, Dillioglugil O, Ozveri H, Akdas A (2008) Asymptomatic retained surgical gauze towl diagnosed 32 years after nephrectomy. Int Urol Nephrol 40:885–888CrossRefPubMedGoogle Scholar
  25. 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 438:398–403CrossRefPubMedGoogle Scholar
  26. 26.
    Gencosmanoglu R, Inceoglu R (2003) An unusual cause of small bowel obstruction: gossypiboma. BMC Surg 3:6CrossRefPubMedGoogle Scholar
  27. 27.
    Dharamsi RD, Jesudason SRB, Rolston DDK (1990) Chronic watery diarrhea due to a surgical pack in the ileal lumen. J Clin Gastroenterol 12:239–241CrossRefPubMedGoogle Scholar
  28. 28.
    Risher WH, McKinnon WM (1991) Foreign body in the gastrointestinal tract: intraluminal migration of laparotomy sponge. South Med J 84:1042–1045PubMedGoogle Scholar
  29. 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 19:377–378CrossRefPubMedGoogle Scholar
  30. 30.
    Mentes BB, Yilmaz E, Sen M et al (1997) Transgastric migration of a surgical sponge. J Clin Gastroenterol 24:55–57CrossRefPubMedGoogle Scholar
  31. 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 13:6605–6607CrossRefPubMedGoogle Scholar
  32. 32.
    Lin TY, Chuang CK, Wong YC et al (1999) Gossypiboma: migration of retained surgical gauze and spontaneous transurethral protrusion. BJU Int 84:879–880CrossRefPubMedGoogle Scholar
  33. 33.
    Yaycioglu O, Ulusan S, Ezer A et al (2007) Uretoreoappendiceal fistula due to gossypiboma. Urol Int 79:187–188CrossRefPubMedGoogle Scholar
  34. 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 265:103–104CrossRefPubMedGoogle Scholar
  35. 35.
    Serra J, Matias-Guiu X, Calabuig R et al (1988) Surgical gauze pseudotumor. Am J Surg 155:235–237CrossRefPubMedGoogle Scholar
  36. 36.
    Richards WO, Keramati B, Scovill WA (1986) Fate of retained foreign bodies in the peritoneal cavity. South Med J 79:496–498PubMedGoogle Scholar
  37. 37.
    Imren Y, Tasoglu I, Ozkose Z (2006) A different intracardiac mass: retained sponge. Echocardiography 23:322–323CrossRefPubMedGoogle Scholar
  38. 38.
    Olnick HM, Weens HS, Rogers JV (1955) Radiological diagnosis of retained surgical sponges. JAMA 159:1525–1527Google Scholar
  39. 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 (
  40. 40.
    Prasad S, Krithnan A, Limdi J, Patankar T (1999) Imaging features of gossypiboma: report of two cases. J Postgrad Med 45:18–19PubMedGoogle Scholar
  41. 41.
    Granetzny A, Holtbecker N, Thomas H et al (2008) Misinterpretation of a pulmonary GI anastomosis stapler line as a retained foreing body. Chest 133:281–283CrossRefPubMedGoogle Scholar
  42. 42.
    Choi BI, Kim SH, Yu ES et al (1988) Retained surgical sponge: diagnosis with CT and sonography. AJR Am J Roentgenol 150:1047–1050PubMedGoogle Scholar
  43. 43.
    Revesz G, Siddiqi TS, Buchheit WA et al (1983) Detection of retained surgical sponges. Radiology 149:411–413PubMedGoogle Scholar
  44. 44.
    Sugano S, Suzuki T, Linuma M et al (1993) Gossypiboma: diagnosis with ultrasonography. J Clin Ultrasound 21:289–292CrossRefPubMedGoogle Scholar
  45. 45.
    Chau WK, Lai KH, Lo KJ (1984) Sonographic findings of intraabdominal foreign bodies due to retained gauze. Gastrointest Radiol 9:61–63CrossRefPubMedGoogle Scholar
  46. 46.
    Cheng TC, Chou AS, Jeng CM et al (2007) Computed tomography findings of gossypiboma. J Chin Med Assoc 70:565–569CrossRefPubMedGoogle Scholar
  47. 47.
    Parienty RA, Pradel J, Lepreux JF et al (1981) Computed tomography of sponges retained after laparotomy. J Comput Assist Tomogr 5:187–189CrossRefPubMedGoogle Scholar
  48. 48.
    Kalovidouris A, Kehagias D, Moulopoulos L, Gouliamos A, Pentea S, Vlachos L (1999) Abdominal retained surgical sponges: CT appearance. Eur Radiol 9:1407–1410CrossRefPubMedGoogle Scholar
  49. 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 20:919–923CrossRefPubMedGoogle Scholar
  50. 50.
    Sheehan RE, Sheppard MN, Hansell DM (2000) Retained intrathoracic surgical swab: CT appearance. J Thorac Imaging 15:61–64CrossRefPubMedGoogle Scholar
  51. 51.
    Sugimura H, Tamura S, Kakitsubata Y et al (1992) Magnetic resonance imaging of retained surgical sponge. Clin Imaging 16:259–262CrossRefPubMedGoogle Scholar
  52. 52.
    Kim CK, Park BK, Ha H (2007) Gossypiboma in abdomen and pelvis: MRI findings in four patients. AJR Am J Roentgenol 189:814–817CrossRefPubMedGoogle Scholar
  53. 53.
    Dux M, Ganten M, Lubienski A et al (2002) Retained surgical sponge with migration into the duodenum and persistent duodenal fistula. Eur Radiol 12:74–77CrossRefGoogle Scholar
  54. 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 28:839–841CrossRefPubMedGoogle Scholar
  55. 55.
    Jain M, Sawhney S (1995) Gossypiboma: ultrasound-guided removal. J Clin Ultrasound 23:321–323CrossRefPubMedGoogle Scholar
  56. 56.
    Uranus U, Schauer C, Pfeifer J et al (1995) Laparoscopic removal of a large laparotomy pad forgotten in situ. Surg Laparosc Endosc 5:77–79PubMedGoogle Scholar
  57. 57.
    Erdil A, Kilciler G, Ates Y et al (2008) Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus. Inter Med 47:613–615CrossRefGoogle Scholar
  58. 58.
    Singh R, Mathur RK, Patidar S et al (2004) Gossypiboma: its laparoscopic diagnosis and removal. Surg Laparosc Endosc Percutan Tech 14:304–305CrossRefPubMedGoogle Scholar
  59. 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 19–34Google Scholar
  60. 60.
    AORN Recommended Practices Committee (2006) Recommended practices for sponge, sharps, and instruments counts. AORN J 433:412–418Google Scholar
  61. 61.
    Sarr MG (2005) Retained foreign bodies—why do we still allow them to occur? Surgery 137:304–305CrossRefPubMedGoogle Scholar
  62. 62.
    Dossett LA, Dittus RS, Speroff T et al (2008) Cost-effectiveness of routine radiographs after emergent open cavity operations. Surgery 144:317–321CrossRefPubMedGoogle Scholar
  63. 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 141:659–662CrossRefPubMedGoogle Scholar
  64. 64.
    Rogers A, Jones E, Oleynikov D (2007) Radiofrequency identification (RFID) applied to surgical sponges. Surg Endosc 21:1235–1237CrossRefPubMedGoogle Scholar
  65. 65.
    Fabian CE (2005) Electronic tagging of surgical sponges to prevent their accidental retention. Surgery 137:298–301CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • George H. Sakorafas
    • 1
  • Dimitrios Sampanis
    • 1
  • Christos Lappas
    • 1
  • Eva Papantoni
    • 1
  • Spyros Christodoulou
    • 1
  • Aikaterini Mastoraki
    • 1
  • Michael Safioleas
    • 1
  1. 1.4th Department of SurgeryAthens University, Medical School, ATTIKON U. HospitalAthensGreece

Personalised recommendations