Forgotten sanitary pad following episiotomy repair: A Case Report

Abstract

Background-Gossypiboma describes an intraoperative mistake discovered postoperatively where surgical sponges, abdominal pack, gauze packs or textile materials are forgotten in the operative field after the patient is closed. This condition is under reported and poses a diagnostic dilemma  because it may be silent for varying durations after the surgery.

Case Presentation-A 23 -year old Para 1+0 pharmacy assistant presented thirty-one months after childbirth to the gynaecology clinic with  complaints of dyspareunia, dysmenorrhoea, offensive menstrual effluent and vaginal discharge since her delivery. She had received an episiotomy,  which had been repaired and she had been discharged on antibiotics and analgesia. She passed red lochia for three days followed by brown  malodorous fluid per vaginam. She experienced severe abdominal pains, high-grade fever, chills and rigors during the puerperium with dyspareunia  and foul smelling vaginal discharge subsequently. She visited several hospitals, and received antibiotics, antimalarials and analgesics,  but symptoms persisted. On examination, significant findings were suprapubic tenderness, brown malodorous discharge, adnexal tenderness and a  mass plugging the cervical os. It was removed and examination revealed a sanitary pad covered in foul-smelling discharge. Symptoms abated but  twelve months after, she presented with inability to conceive and was referred for infertility evaluations.

Conclusion- Competent doctors should supervise less experienced colleagues to forestall these gaps which can lead to legal action and maternal  morbidity and possibly mortality. Repeat pelvic examinations should be performed after vaginal procedures, and women presenting with abdominal  and genital symptoms should receive exhaustive evaluations.