To our knowledge, this is the first reported case of gossypiboma in Sudan in 2024.Despite many previous studies discussing gossypiboma as one of the medical errors occurring in surgery, there is still evidence of the prevalence of such errors worldwide. In Sudan, this issue may be addressed by conducting a root cause analysis to investigate all causes of this phenomenon and addressing them accordingly.
Gossypibomas is a major concern especially in the African countries where incidents of such cases are keep appearing year after year with serous and life threatening complications in some of them [9]. Here, we analyse various aspects of our reported case by comparing it to similar cases reported in Africa over the past five years, in order to offer a broader contextual understanding of the situation. The presented case involves a 37-year-old multiparous female with a history of ten pregnancies and ten previous deliveries, presenting with abdominal pain and a history of an emergent caesarean section. Clinical examination, laboratory findings, and imaging studies led to the diagnosis of an ovarian cyst. However, subsequent surgical exploration revealed an unexpected and intriguing finding – a cyst filled with gauze adherent to the ovary and jejunum. The initial clinical presentation of the patient with abdominal pain and a palpable mass raised suspicion for an ovarian cyst, a common gynaecological condition. However, the unusual discovery during surgery emphasizes the importance of careful preoperative evaluation and thorough exploration in the operating room. The nature of the mass, filled with gauze, raises questions about its origin and how it became adherent to both the ovary and jejunum. A detailed history may provide clues, such as any previous surgical interventions, gynaecological procedures, or abdominal surgeries. The presence of gauze suggests the possibility of a retained surgical sponge, a rare but well-documented occurrence in the literature. The macroscopic examination, as illustrated in Figs. 1 and 2 shows the cystic structure surrounded by mixed inflammatory cellular infiltration. The absence of malignant features reported by the histopathologist is reassuring, ruling out neoplastic aetiologies. A similar case was reported in Sudan in 2023, involving a 24-year-old female with a history of emergency caesarean section. which was also presented after two years of the operation however it was complicated by the development of abdominal obstruction. the difference in age and presentation requires more care from the practitioner when confronted with a suspectable case of gossypiboma [10]. while laparoscopic surgeries are usually considered safer alternatives when compared with classical surgery, there has about been report before about missed gossypibomas after laparoscopic abdominal surgeries, which means that care should also be taken with this type of surgeries [11].
Another African case of gossypiboma was reported in 2022, where a 31-year-old woman presented to the emergency room with similar complaints after three weeks of a cesarean section. Despite the age difference between these cases, the overall clinical prognosis is the same, as most patients show improvement after the foreign body is removed [12]. The management of such cases involves a multidisciplinary approach. The surgical team, in collaboration with gynecologists and general surgeons, must navigate the intricacies of the anatomy involved and carefully dissect adhesions to achieve complete excision. The adherence of the mass to the jejunum introduces an additional layer of complexity, requiring meticulous surgical skills to avoid inadvertent injuries. Postoperatively, the patient’s recovery was uneventful, supported by intravenous fluids and antibiotics for five days. This successful outcome underscores the significance of prompt recognition and intervention in unexpected surgical findings. Contrary to our situation, the prolonged presence of gossypiboma can put pressure on adjacent organs, potentially causing them to perforate. This was highlighted in a recent study by Berhanu N. Alemu and Abraham G. Tiruneh, who documented a case of a patient experiencing abdominal discomfort one year after a cesarean section. Further investigation revealed that the discomfort was due to a gossypiboma leading to a perforated cecum. Timely recognition and intervention could significantly reduce the risk of such complications occurring [7]. This case and similar African-reported cases of gossypiboma underscore the diagnostic challenges that can arise in routine clinical practice. The unexpected discovery of a cyst filled with gauze during surgery emphasizes the need for thorough exploration and a high index of suspicion for retained surgical items.
Preventing retained lap sponges and gossypibomas in the operating theatre requires a multifaceted approach, emphasizing stringent protocols, personal accountability and a collaborative environment [13]. One critical measure is the meticulous instrument and sponge counts conducted at multiple stages: before the procedure, during the procedure, and before wound closure. A standardized checklist, as part of the surgical safety protocol, ensures that all items are accounted for. The atmosphere in the operating room must support a culture of safety where any team member, regardless of hierarchy, feels empowered to challenge the surgeon or operating staff if discrepancies are noted [14]. For instance, if a sponge count is incorrect or an instrument is unaccounted for, member of the operating team should confidently raise the issue without fear of reprimand. Moreover, it was found that these safety practices has to be adjusted according to the nature of the operation and the number of the available staff to ensure the prevention of these events [15].
Advanced technologies such as radiofrequency identification (RFID) or bar-coded sponges can further enhance detection and accountability. Real-world examples of prevention include implementing mandatory “time-out” procedures where the team collectively reviews the count and confirming the absence of retained materials through intraoperative imaging when necessary. This integrated approach significantly reduces the risk of retained surgical items and promotes a culture of shared responsibility for patient safety.
Multidisciplinary collaboration and careful surgical management are essential for optimal patient outcomes in such unusual cases. Future considerations may include a review of protocols to prevent retained surgical items and enhanced communication among healthcare teams to minimize such occurrences.
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