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Year : 2000  |  Volume : 10  |  Issue : 3  |  Page : 188-189
Gossypiboma


Skylab Diagnostic Centre, Guwahati, Assam, India

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How to cite this article:
Hazarika K, Barua S. Gossypiboma. Indian J Radiol Imaging 2000;10:188-9

How to cite this URL:
Hazarika K, Barua S. Gossypiboma. Indian J Radiol Imaging [serial online] 2000 [cited 2020 Jan 25];10:188-9. Available from: http://www.ijri.org/text.asp?2000/10/3/188/30597
Sir,

A thirty-five years old lady was referred to us for abdominal sonography. Her presenting complaint was episodic pain in the abdomen and low-grade fever. Clinical examination did not reveal any abnormality related to her symptoms. Her routine blood and urine parameters were well within normal range, except than she was mildly anemic. She had undergone an appendectomy five years earlier.

An abdominal ultrasonogram was performed which revealed a hypoechoic mass in the para umbilical area with a bright, central, echogenic line casting an intense acoustic shadow [Figure - 1] This was diagnosed as a gossypiboma.

Gossypiboma is the term used to describe a retained surgical sponge. Surgical foreign bodies are retained more commonly than is suspected. About 50% will become symptomatic by eroding into the bowel or vessels or by causing fistulae, abscesses, obstruction, bleeding or chronic pain. Expeditious removal is recommended. Laparoscopic retrieval is feasible especially if discovered early.

In most countries surgical sponges have radio-opaque markers and thus can be easily detected by plain abdominal radiographs. Reports from Japan and Korea reveal that surgical sponges without such markers are still occasionally used [1]. In our country such radio-opaque surgical sponges are not readily available. Sonography, therefore, is the imaging modality of choice in suspected cases of retained surgical sponges.

A retained sponge in the abdominal cavity, in most cases, stimulates an aseptic inflammatory reaction causing adhesions, fibrosis and a capsule formation. In most instances, it causes no symptoms. Occasionally the process in organized and it may become an abdominal mass. In some cases, because of secondary infection, an abscess is formed which is associated with local tenderness and fever, leading to early diagnosis.

The mass due to the retained sponge may cause pressure effect on the adjacent organs. There are several reports about the body's attempt to expel this foreign body. Erosion and migration of the invader into an adjacent hollow viscus, either the intestine or the urinary bladder, have been reported [2]. Occasionally there may be calcification [3].

Several sonographic features of retained surgical sponges have been documented but none of them is considered specific for a definite diagnosis [4]. They may present as cystic masses with echogenic, wavy stripes in the centre, casting acoustic shadows [3],[4]. Abscess organized hematoma and pseudo-cystic mass are the differential diagnoses to be accounted for. Sugano et al [4] emphasize the fact that the intensity depends on the amount of gauze present.

Kukubo et al [3] reiterates that the linear acoustic shadow may occur even in the absence of air or calcification in the mass caused by the retained sponge. Furthermore, if either calcification or air does occur in the mass, the intensity of the shadowing is inappropriately high, relative to the amount of air or calcification. When a mass with hyperechoic wavy structures and posterior acoustic shadowing is seen on ultrasonography, the history of previous surgery must be questioned. Gossypiboma should be included in the differential diagnosis of such cases.

 
   References Top

1.Manashe B, Yehudit G, Natan P. Imaging of retained surgical sponge. Ultrasound International 1997:3:157-161.   Back to cited text no. 1    
2.Choi BI, Kim SH, Yu ES, Chang H S, Han MC, Kim C W. Retained Surgical Sponge: Diagnosis with CT and Sonography. AJR 1988; 150: 1047-1050.   Back to cited text no. 2    
3.Kukubo T, Itai Y, Ohtomo K, Yoshikawa K, Lio M, Atomi Y. Retained surgical sponges: CT and US appearance: Radiology 1987; 165: 415-148.   Back to cited text no. 3    
4.Sugano S, Suzuki T, Linuma M, et al . Gossypiboma: diagnosis with Ultrasonogorpahy. J Clin Ultrasound 1993; 21: 289-292.  Back to cited text no. 4    

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Correspondence Address:
Karuna Hazarika
Skylab Diagnostic Centre, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


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