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Case 71 - Gossypiboma

from Section 10 - Peritoneal cavity

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

A gossypiboma is a retained surgical sponge or swab, derived from gossypium (Latin; cotton) and boma (Swahili; place of concealment) [1]. Sponges are manufactured with various radiopaque markers. The two commonest markers look like a short piece of crumpled radiopaque scotch-tape (Figure 71.1) or a small tangle of wire (Figure 71.2). While these markers are made to be easily seen, in reality they may be obscured by extraneous paraphernalia and poor image quality due to the challenges of x-raying a patient with portable equipment in the operative or early postoperative setting (Figure 71.3). Retained sponges or swabs may also go unrecognized because they are rare and do not “belong” to any of the usual radiology subspecialties, so that many radiologists have limited training in the recognition of gossypibomas. At CT, retained sponges appear as soft-tissue density masses (Figure 71.4), and may show a whorled texture or a “spongiform” pattern with contained gas bubbles [2]. The latter may persist for many months, even when sterile [3]. At MRI, a retained sponge is typically seen as a soft-tissue density mass with a thick well-defined capsule and a whorled internal configuration on T2-weighted imaging (Figure 71.5) [4].

Importance

Radiologically, gossypibomas may go unrecognized or be confused with postoperative collections or tumors. Retained surgical foreign bodies are of major administrative importance because they are regarded as a “never event” by the Center for Medicare and Medicaid Services. The associated medical and liability costs have been estimated at over $200,000 per incident [5].

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
, pp. 238 - 241
Publisher: Cambridge University Press
Print publication year: 2010

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References

O'Connor, AR, Coakley, FV, Meng, MV, Eberhardt, SC.Imaging of retained surgical sponges in the abdomen and pelvis. Am J Roentgenol 2003; 180: 481–489.CrossRefGoogle ScholarPubMed
Kalovidouris, A, Kehagias, D, Moulopoulos, L, et al. Abdominal retained surgical sponges: CT appearances. Eur Radiol 1999; 9: 1407–1410.CrossRefGoogle Scholar
Kopka, L, Fischer, U, Gross, AJ, et al. CT of retained surgical sponges (textilomas): pitfalls in detection and evaluation. J Comput Assist Tomogr 1996; 20: 919–923.CrossRefGoogle ScholarPubMed
Furukawa, H, Hara, T, Taniguchi, T.Two cases of retained foreign bodies after cholecystectomy: diagnosis by sonography, CT, angiography and MRI. Jpn J Surg 1991; 21: 566–570.CrossRefGoogle ScholarPubMed
Regenbogen, SE, Greenberg, CC, Resch, SC, et al. Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness. Surgery 2009; 145: 527–535.CrossRefGoogle ScholarPubMed
Lauwers, PR, Hee, RH.Intra-peritoneal gossypibomas: the need to count sponges. World J Surg 2000; 24: 521–527.CrossRefGoogle Scholar
Kaiser, CW, Friedman, S, Spurling, KP, Slowick, T, Kaiser, HA.The retained surgical sponge. Ann Surg 1996; 224: 79–84.CrossRefGoogle ScholarPubMed
Barriga, P, Garcia, C.Ultrasonography in the detection of intra-abdominal retained surgical sponges. J Ultrasound Med 1984; 3: 173–176.CrossRefGoogle ScholarPubMed

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  • Gossypiboma
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.072
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  • Gossypiboma
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.072
Available formats
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  • Gossypiboma
  • Fergus V. Coakley, University of California, San Francisco
  • Book: Pearls and Pitfalls in Abdominal Imaging
  • Online publication: 05 November 2011
  • Chapter DOI: https://doi.org/10.1017/CBO9780511763229.072
Available formats
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