Indian Journal of Surgery

, Volume 74, Issue 4, pp 318–322 | Cite as

Gossypiboma and Surgeon- Current Medicolegal Aspect – A Review

  • Rabi Sankar Biswas
  • Suvro Ganguly
  • Makhan Lal Saha
  • Subhasis Saha
  • Subhabrata Mukherjee
  • Asif Ayaz
Review Article


Gossypiboma or textiloma is referred to as a surgical gauze or towel inadvertently retained inside the body following surgery. It is an infrequent but avoidable surgical complication, which must be kept in mind in any postoperative patient who presents with pain, infection, or palpable mass. Gossypiboma, in the doctrine of res ipsa loquitur, proves that the surgeon is negligent. Moreover, it has medicolegal consequences including mental agony, humiliation, huge monetary compensation and imprisonment on the part of the surgeon and increased morbidity, mortality and financial loss on the part of the patient. Here we report two cases of gossypiboma and review its current medicolegal aspect in relation to the surgeon.


Gossypiboma Medical negligence Medicolegal aspect 


  1. 1.
    IV (2006) CPJ 105 NC Bench: S G Member, P Shenoy K Ravindra Nath (Dr) And Anr. vs Vitta Veera Surya Prakasam And Ors. on 17/8/2006Google Scholar
  2. 2.
    Stawicki SP, Evans DC, Cipolla J, Seamon MJ, Lukaszczyk JJ, Prosciak MP et al (2009) Retained surgical foreign bodies: a comprehensive review of risks and preventive strategies. Scard J Surg 98:8–17Google Scholar
  3. 3.
    Dakubo J, Clegg-Lamptey JN, Hodasi WM, Obaka HE, Toboh H, Asempa W (2009) An intra-abdominal grossypiboma. Ghana Med J 43(1):43–45PubMedGoogle Scholar
  4. 4.
    Qamar SA, Jamil M, Idress T, Sobia H (2010) Retained foreign bodies after intra-abdominal surgery: a continuing problem. Prof Med J 17(2):218–222Google Scholar
  5. 5.
    Paramythiotis D, Michalopoulos A, Papadopoulos VN, Panagiotou D, Papaefthymiou L, et al (2011) Gossypiboma presenting as mesosigmoid abscess: an experimental study. Tech Coloproctol (Suppl 1):S67–S69Google Scholar
  6. 6.
    Tarik U, Gokhan DM, Sunay YM, Mahmut A (2009) The medico-legal importance of gossypiboma. 4thMediterranean Academy of Forensic Science Meeting, 14–18 October 2008, Antalya-Turkey. Abstract CD of Poster Presentations:82–83Google Scholar
  7. 7.
    Kokubo T, Itai Y, Ohtomo K, Yoshikawa K, Iio M, Atomi Y (1987) Retained surgical sponges: CT and US appearance. Radiology 165:415–418PubMedGoogle Scholar
  8. 8.
    Fair GL (1953) Foreign bodies in abdomen causing obstruction. Am J Surg 86:472–475PubMedCrossRefGoogle Scholar
  9. 9.
    William RG, Bragg RG, Nelson JA (1978) Gossypiboma—the problem of the retained surgical sponge. Radiology 129:323–326Google Scholar
  10. 10.
    Kaiser CW, Friedman S, Spurling KP, Slowick T, Kaiser HA (1996) The retained surgical sponge. Ann Surg 224:79–84PubMedCrossRefGoogle Scholar
  11. 11.
    Sarker MM, Golam Kibria AKM, Haque MM, Sarker KP, Rahman MK (2006) Spontaneous transmural migration of a retained surgical mop into the small intestinal lumen causing sub-acute intestinal obstruction: a case report. TAJ 19(1):34–37Google Scholar
  12. 12.
    Gupta NM, Chaudhary A, Nanda V, Malik AK (1985) Retained surgical sponge after laparotomy, unusual presentation. Dis Colon Rectum 28:451–453PubMedCrossRefGoogle Scholar
  13. 13.
    Kubota A, Haniuda N et al (2000) A case of retained surgical sponge (gossypiboma) and MRI features. Jpn J Gastroenterol Surg 33:1719–1723CrossRefGoogle Scholar
  14. 14.
    Robinson KB, Levin EJ (1966) Erosion of retained surgical sponges into the intestine. AJR 96:339–343Google Scholar
  15. 15.
    Düx M, Ganten M, Lubienski A, Grenacher L (2002) Retained surgical sponge with migration into the duodenum and persistent duodenal fistula. Eur Radiol 12:874–877Google Scholar
  16. 16.
    Hyslop J, Maull K (1982) Natural history of retained surgical sponges. South Med J 75:657–660PubMedCrossRefGoogle Scholar
  17. 17.
    Mason LB (1968) Migration of surgical sponge into small intestine. JAMA 205:122–123Google Scholar
  18. 18.
    Crossen HA, Crossen DF (1940) Foreign bodies left in the abdomen. CV Mosby Co, St Louis, p 49Google Scholar
  19. 19.
    Chau WK, Lai KH, Lo KJ (1984) Sonographic findings of intra-abdominal foreign bodies due to retained gauze. Gastrointest Radiol 9:61–63PubMedCrossRefGoogle Scholar
  20. 20.
    Sheward JE, Williams AG, Mettler FA (1986) CT appearance of a surgically retained towel; (Gossypiboma). J Comput Assist Tomogr 10:343–345PubMedCrossRefGoogle Scholar
  21. 21.
    Naik KS, Carrington BM, Yates W, Clarke NW (2000) The post-cystectomy pseudotumour sign: MRI appearances of a modified chronic pelvic haematoma due to retained haemostatic gauze. Clin Radiol 55:970–974PubMedCrossRefGoogle Scholar
  22. 22.
    National Association of Theatre Nurses (2005) Swab, instrument and needles count. In: NATN standards and recommendations for safe perioperative practice. Harrogate, pp 233–237Google Scholar
  23. 23.
    Association of peri-Operative Registered Nurses (2007) Recommended practices for sponge, sharp, and instrument counts. In: Standards, recommended practices and guidelines. AORN Inc., Denver, CO, pp 493–502Google Scholar
  24. 24.
    Australian College of Operating Room Nurses and Association of peri-Operative Registered Nurses (2006) Counting of accountable items used during surgery. In: Standards for perioperative nurses. ACORN, O’Halloran Hill, South Australia, pp 1–12Google Scholar
  25. 25.
    Operating Room Nurses Association of Canada (2007) Surgical counts. In: Recommended standards, guidelines, and position statements for perioperative nursing practice. Canadian Standards Association, MississaugaGoogle Scholar
  26. 26.
    South African Theatre Nurse (2007) Swab, instrument and needle counts. In: Guidelines for basic theatre procedures. Panorama, South AfricaGoogle Scholar
  27. 27.
    American College of Surgeons. Statement on the prevention of retained foreign bodies after surgery. (accessed 5 February 2008)
  28. 28.
    Berlin L (2009) Malpractice issues in radiology: res ipsa loquitur. AJR Am J Roentgenol 193(6):1475–1480PubMedCrossRefGoogle Scholar
  29. 29.
    Agarwal BB (2009) A self-tailored hernia mesh using lightweight material: a note of caution—res ipsa loquitur. Surg Endosc 23(7):1684–1685, Epub 2009 May 23PubMedCrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2012

Authors and Affiliations

  • Rabi Sankar Biswas
    • 1
  • Suvro Ganguly
    • 2
  • Makhan Lal Saha
    • 3
  • Subhasis Saha
    • 4
  • Subhabrata Mukherjee
    • 5
  • Asif Ayaz
    • 6
  1. 1.Institute of Post Graduate Medical Education and ResearchKolkataIndia
  2. 2.Institute of Post Graduate Medical Education and ResearchKolkataIndia
  3. 3.Institute of Post Graduate Medical Education and ResearchKolkataIndia
  4. 4.Institute of Post Graduate Medical Education and ResearchKolkataIndia
  5. 5.Institute of Post Graduate Medical Education and ResearchDistrict- HooghlyIndia
  6. 6.Institute of Post Graduate Medical Education and ResearchKolkataIndia

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