Retained foreign bodies

Estimated to be 1:1000-5000 after operations.

A retained laparotomy sponge more likely to occur in obese, patients, during emergency surgery or in instances when changes in operative procedure occur.

Morbidity may be as high as 50% with a mortality around 10%.

The problem of retained surgical bodies (RSB) after surgery is an issue for surgeons, hospitals and the entire medical team.

Consequences for the patient as they can be life threatening and usually, a further operation is necessary.

The incidence of RSB is between 0.3 to 1.0 per 1,000 abdominal operations, and they occur due to a lack of organization and communication between surgical staff.

Typically, the RSB are surgical sponges and instruments located in the abdomen, retroperitoneum and pelvis.

The consequence of foreign bodies after surgery may manifest immediately after the operation, months or even years after the surgical procedure.

The number of cases in which foreign bodies are left behind during a procedure in the United States has been estimated at around 1500 cases per year.

The risk of retained surgical bodies increases in complicated cases such as obese patients or trauma requiring the use of numerous instruments, retractors and surgical sponges.

The discovery of the foreign bodies after surgery may occur due to non-specific complaints.

They can present as a mass in the abdominal cavity and can be diagnosed during a routine radiological examination.

Frequent infections and a palpable mass suggest the presence of retained surgical bodies.

Sponges are the most common foreign bodies retained in the human body after, being located in body cavities such as the abdomen, pelvis and retroperitoneal space.

Retained surgical sponge is ref2242ed to a a gossypiboma.

These sponges may remain in the body for days, months or even years before manifesting as inflammatory reactions.

When retained bodies are suspected, diagnosis must be confirmed by computed tomography (CT).

Surgical instruments such as clamps, retractors, electrodes or drains can be left behind after operations, especially in the abdominal cavity.

All foreign bodies have the potential to cause pain, obstruction, ileus or abscess.

Approximately 80% of casesthe number of declared materials was felt to be correct at the end of the operation.

Retention of foreign bodies after surgery has medical and legal implications, occurring as a result of mistakes by the entire medical team, not just the surgeon.

Before every operation instruments are counted by the scrub nurse and they are counted at the end of the procedures to ensure that they have all been accounted for.

Clinical manifestation of retained surgical bodies after surgical procedure manifest differently depending on their location and the type of material implicated.

While retained foreign bodies can remain in many tissues, they are commonly located in the abdominal cavity.

Retained foreign bodies inside the abdominal cavity can produce pain, have a mass effect, be associated with an intraabdominal abscess, obstructive ileus, intestinal perforation, gastrointestinal fistula, bleeding and can migrate transmurally.

Retained foreign bodies can manifest as acute inflammatory response, infection or abscess within days or weeks after the operation.

Retained foreign bodies manifest as aseptic inflammation or exudative without infection, leading to nonspecific manifestation.

Patients may complain of pain and discomfort months or years after their procedure.

Acute reactions to RSFB require immediate attention for further diagnosis and urgent surgery to remove the foreign body.

The procedure to retrieve the RSFB is very successful if performed soon after the first procedure

In the early postoperative state foreign bodies can be detected by X-ray or can manifest as an inflammatory reaction.

In the acute time period, attempting to remove the RSB laparoscopically is initiated.

With a chronic manifestation months or even years after the first procedure, it is important to perform a CT scan first as a tumor-like mass or bowel obstruction, as well as various types of fistulae may be involved.

The RSB can be organized as a mass inside the abdominal cavity, and a tumor may be suspected ,in which case, extensive diagnostic imaging can distinguish the RSB from a tumour mass,

Gi brinous changes can result in granulomatous reactions and adhesions, and in some cases an abscess, and manifest with clinical signs of infection.

Inflammation in the area surrounding the retained surgical sponge and may be associated with a bowel obstruction, or it can lead to perforation of the intestinal wall and pathological communication between the adjacent structures resulting in fistula formation.

Gastrointestinal bleeding from the upper gastrointestinal tract can also occur and may be life threatening.

Transmural migration of the RFB can cause an intestinal obstruction when the RSB migrates from the abdominal to intraluminal space of the bowel .

Approximately 88% of RSB cases occur in a situation where the sponge and instrument counts were declared correct.

Counting the surgical materials used during the surgical procedure is the responsibility of the nurses under a direction of the doctors.

Counts should be performed before the procedure begins and whenever new additional items are used during the operation, before the surgeon closes the body cavity, when the surgeon begins to close the wound; and when the surgeon closes the skin.

In the majority of cases where sponges were left behind, the number of sponges before closing was always declared correct, suggesting that counting alone is not sufficient.

Body mass index, intraoperative complications and unexpected events are associated with an increased risk for retained bodies after surgical procedures.

A breakdown in communication within the operation team is the most important factor in relation to the issue of surgical bodies.

Radiopaque surgical instruments and devices should be apparent on plain films.

The characteristic appearance of radiopaque tape or wires of laparotomy pads and surgical sponges, respectively, should indicate their presence.

The diagnosis of retained bodies can also be made using CT and gastrointestinal contrast studies.

Communication within the surgical team is major factor to minimize the number of surgical bodies left after surgical operations in the body cavity.

Leave a Reply

Your email address will not be published. Required fields are marked *