A 42-year-old male presenting as pericardial mass
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A 42-year-old man visited to emergency room due to abdominal pain that had started 8 h before. He has no underlying medical illness except a history of repair of ventricular septal defect at 20 years ago. He had a history of patch closure due to ventricular septal defect 20 years ago and was a 20-pack-year ex-smoker.
Pathology confirmed that this 6.7 × 5.5 × 4.0-cm-sized mass was a retained gauze at the time of surgery 20 years ago (Fig. 1e, f). The patient had a dramatic improvement and discharged.
“Gossypiboma” is a technical term for surgical complications resulting from foreign materials. It originated from the Latin word for cotton, “gossypium” plus “boma” which means a place of concealment in Swahili. The term is related to the fact that surgical gauze was made with cotton in the past. It is now made from other materials, so the term does not really fit the current situation . It has been reported that it has an incidence of 1 in every 5500–18,760 operations, happening more commonly in abdominal cavity surgery. Because it is usually asymptomatic and can often be associated with lawsuits, the incidence tends to be under reported .
There have been several studies to unearth the potential risk factors associated with retained surgical items. The most commonly found retained foreign body was the surgical sponge. Multivariate analysis showed that emergency operation, unexpected change in surgical procedure, and high BMI of the patient were risk factors for retention of a foreign body .
To minimize the events, scrupulous surgical counting should be held as dictated by the governing hospital protocol and a new count should be performed whenever there is change in the surgical team or the intended procedure. Using small-sized pads and sponges should be avoided if possible as they can easily lodge between the tissues and bowel loops and stain with blood, making their identification difficult .
Compliance with ethical standards
Conflict of interest
Hyun Ju Yoon, Kye Hun Kim, Jae Yeong Cho, Hyuk Jin Park, Hyung Yoon Kim and Jong Chun Park declare that they have no conflict of interest.
Human rights statements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.
Informed consent was obtained from all patients for being included in the study.
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