Gossypiboma - A Rare Diagnosis with Significant Medicolegal Implications: A Case Report

Abstract

Gossypiboma describes the inadvertent abandonment of cotton material (sponge or swab) within the body of a patient by the surgeon at the end of surgery. The patient may or may not manifest symptoms; these symptoms vary according to the site and the type of inflammatory reaction. Clinical diagnosis is difficult, and radiology plays a pivotal role. Its management can result in further medical errors and ultimately, litigations. The authors report a 34-year-old woman, with a history of two previous caesarean sections, who presented with features of intestinal obstruction. Physical examination showed a pfannensteil scar, right iliac fossa mass, and ascites. Computed Tomography (CT) scan revealed a lesion, in the paracaecal area, with an emphysematous core, and enhancing thick rim. A standard right hemicolectomy with ileo-transverse anastomosis were done for a suspected caecal tumour. Histopathological gross evaluation revealed a bulbous paracaecal mass of cotton wool and guaze. Microscopy showed scattered cotton material surrounded by mixed inflammatory cells including foreign-body type giant cells. A histopathological diagnosis of gossypiboma was made. The medical and legal consequences of gossypibomas are traumatising for the surgeon and the patient. Diagnosis requires a high suspicion index with good radiological and histopathological support. Adhering to preventive protocols, such as swap count at the end of surgery, is strongly advocated. This report discusses the surgical, radiological, pathological, and medicolegal aspects of gossypiboma.