Gossypiboma or textiloma is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin gossypium (“cotton wool, cotton”) and the Swahili boma (place of concealment) and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma.[1][2] "Textiloma" is derived from textile (surgical sponges have historically been made of cloth) and the suffix "-oma", meaning a tumor or growth, and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.[1]
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The actual incidence of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations[2] and are most frequently discovered in the abdomen.[3] The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.[1]
Gossypibomas can often present, clinically or radiologically, similar to tumors and abscesses, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity.[3] Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma.[1] Symptoms may not present for long periods of time, sometimes months or years following surgery.[1]
To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORN).[4] Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.[5] Other guidelines have been promoted by the American College of Surgeons and the Joint Commission.[6]
In most countries, surgical sponges contain radiopaque material that can be readily identified in radiographic and CT images, facilitating detection.[1] In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.[7] Some surgeons recommend routine postoperative X-ray films after surgery to reduce the likelihood of foreign body inclusion.[7]