Abstract | December 20, 2022

A Rare Case of Retained Surgical Towel Presenting as GERD

Presenting Author: Sohni Pathan, BSA, Medical Student, 4th Year, Nova Southeastern University Dr. Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, Florida

Coauthors: Erik Perez, BS, Medical Student, 4th Year, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine; Alexandria Miller, MD, Internal Medicine, PGY2, Broward Health North, Fort Lauderdale, FL; Jordy Godinez, MD, Hospitalist, Internal Medicine, Broward Health North, Fort Lauderdale, FL.

Learning Objectives

  1. Identify signs and symptoms relating to a possible retained surgical towels
  2. Differentiate between the presenting symptoms of small bowel obstruction, GERD, and retained surgical towels
  3. Explore possible solutions to prevent sentinel events such as retained surgical towels

Introduction: A gossypiboma, derived from the Latin gossypium (cotton) and the Swahili boma (place of concealment), refers to a surgical gauze or towel unintentionally retained within a body cavity. Retained foreign bodies can serve as a nidus for infection, potentially leading to peritonitis, sepsis, and even death. 

 

Case Description: We present a 43-year-old female, with a history of GERD and anemia who presented to the emergency department with dull, crampy left-sided abdominal pain that began three hours after eating a large meal. Her review of systems was grossly negative aside from her abdominal pain. Her surgical history included two C-section deliveries as well as a hysterectomy following her last C-section in 2016.

On primary survey, the patient was afebrile and her vitals were within normal limits. Physical examination of the patient was positive for mild epigastric and left upper quadrant pain with no rebound or involuntary guarding. Her abdomen was otherwise soft, nondistended, with normoactive bowel sounds and no palpable masses.

Initial laboratory findings demonstrated a hemoglobin of 6 g/dL. CT with IV Contrast showed an indeterminate large abdominal mass, measuring 18 cm x 11.2 cm x 8.9 cm.

 

Final Diagnosis: Due to imaging and laboratory findings, the patient was preliminarily diagnosed with retained surgical item as well as severe anemia, likely secondary to blood loss.

 

Management/Follow-up: The patient felt relief of her symptoms after administration of calcium carbonate-magnesium hydroxide, Donnatal, and viscous Lidocaine 2%. On day two of admission, the patient remained asymptomatic with stable vital signs, and received two units of packed red blood cells. Because of her severe anemia and imaging findings, surgery was consulted to perform an exploratory laparotomy. 

Exploratory laparotomy revealed gross ascites and a 45 cm x 32 cm x 2 cm rectangular shaped foreign body, possibly consistent with a towel. Four pieces of small bowel adhered to a section of large bowel, and were consequently resected and anastomosed. Following an uncomplicated surgery, the patient was admitted for continued management. She was discharged three days after surgery with complete recovery from symptoms.

 

References:

  1. Biswas, RS, Ganguly S, Saha, ML, Saha, S, Mukherjee, S, & Ayaz, A. (2012). Gossypiboma and Surgeon- Current Medicolegal Aspect – A Review. Indian Journal of Surgery, 74(4), 318–322. https://doi.org/10.1007/s12262-012-0446-3
  2. Gibbs, V. C. (2011). Retained Surgical Items and Minimally Invasive Surgery. World Journal of Surgery, 35(7), 1532–1539. https://doi.org/10.1007/s00268-011-1060-4
  3. Hyslop JW, Maull KI. (1982). Natural history of the retained surgical sponge. South Med J. Jun;75(6):657-60. doi: 10.1097/00007611-198206000-00006. PMID: 7089613.
  4. Copeland AW. (2021). Retained surgical sponge (gossypiboma) and other retained surgical items: Prevention and management. UpToDate. 
  5. Schwartz’s Principles of Surgery, 11e. Chapter 12: Quality, Patient Safety, Assessments of Care, and Complications; “Never Events” in Surgery.

 

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