Surgical sponges have been accidentally left inside the patient. Although rare, such instances do occur. Retained surgical sponges are called gossypiboma. Some of the likely reasons include emergency surgery, any unplanned change in the surgical procedure, hasty sponge counts, long surgeries, inexperienced and inadequate staff. The clinical features are usually non-specific and may even take several years after the surgery to become evident. Intra-luminal migration of retained sponges is not very common.

This article describes the case of a 62-year-old patient who presented to the casualty ward with colicky dull abdominal pain along with constipation, vomiting and gradual progressive abdominal distension for three weeks but was able to pass flatus. About 17 months back, the patient had undergone laparotomy with appendicectomy due to ruptured appendicitis after which she started complaining of non-specific abdominal pain, which progressively worsened to symptoms of intestinal obstruction. Plain x-ray of abdomen showed multiple air-fluid levels. The patient was taken up for laparotomy under antibiotic cover with a diagnosis of intestinal obstruction secondary to postoperative adhesions.

Multiple adhesions between bowel loops were seen. A palpable mass (gossypiboma) was found in the sigmoid colon, which was resected and end-to-end colorectal anastomosis done. Histopathology of the specimen also showed a 15 × 10 cm laparotomy towel, which had migrated into the bowel lumen causing obstruction. Obesity, sponge count done just once, surgery duration (1 hour 2 minutes) were identified as the risk factors for the gossypiboma; also, surgery was an done as an emergency procedure. The patient recovered well and was discharged. 

Retained sponges have serious consequences not only for the patient, but also the surgeon because of the medicolegal implications. It is important for surgeons to be aware of the risk factors resulting in retained sponges. It is a preventable complication and can be avoided by meticulous sponge counts along with instrument count, both prior to the surgery and at the end of the surgery, thorough systematic wound examination and abdominal exploration before closure and avoiding the use of small sponges during laparotomy. No staff changes should happen during the surgery. A high index of suspicion is required to diagnose gossypiboma along with correlation between patient history, findings on physical examination and investigations.

Yorke J, et al. Int J Surg Res Pract 2019;6:104.