Sonarkar Rajiv, Wilkinson Raju, Nazar Zansher, Gajendra Giriraj, Sonawane Shreyas
N. K. P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India.
N. K. P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India.
Int J Surg Case Rep. 2020;77:206-209. doi: 10.1016/j.ijscr.2020.10.081. Epub 2020 Oct 23.
Textiloma or Gossypiboma is a mass comprising of cotton matrix within the body left accidentally during a surgical procedure. It is estimated that retained surgical foreign bodies occur one in every 5,500-18,760 inpatient operations but the incidence may be as high as one out of every 1,000-1,500 abdominal cavity operations, and even more common during emergency surgeries. There have also been rare case reports of Transmural migration of retained surgical swab which is a rare phenomenon. But even rarer is the incidence of retention of swab inside the small intestine in the previous procedure.
A 29-year-old female coming with chief complaints of pain in abdomen since 1 year which was colicky in nature, present all over abdomen, non-radiating. The pain aggravated on eating food. Patient also noticed a lump in her abdomen since past 1 year. Abdomen was opened and the bowel was inspected. Enterotomy was performed and two swabs were removed from the intestine.
Prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio opaque marker.
Although rare, a diagnosis of retention of swab or surgical instruments must be considered in cases of vague lumps in abdomen or in cases of intestinal obstruction, especially if the patient has had previous history of laparotomy.
纺织瘤或棉球瘤是手术过程中遗留在体内的由棉花基质构成的肿块。据估计,住院手术中手术异物残留的发生率为每5500 - 18760例中有1例,但在腹腔手术中发生率可能高达每1000 - 1500例中有1例,在急诊手术中更为常见。也有罕见的关于手术拭子经壁迁移的病例报告,这是一种罕见现象。但更罕见的是前次手术中拭子遗留在小肠内的情况。
一名29岁女性,主要主诉为腹部疼痛1年,疼痛性质为绞痛,全腹弥漫性发作,无放射痛。进食后疼痛加剧。患者在过去1年中还注意到腹部有一个肿块。打开腹腔并检查肠道。进行肠切开术,从肠道中取出两个拭子。
除了在手术结束时对手术部位进行彻底探查外,通过仔细清点手术材料,以及常规使用含有不透射线标记物的手术纺织材料,可以预防这种情况。
尽管罕见,但对于腹部出现不明肿块或肠梗阻的病例,尤其是患者有剖腹手术史时,必须考虑拭子或手术器械残留的诊断。