Ahmed Arisha, Lohiya Sushil
Surgery, Krishna Institute of Medical Sciences (KIMS) - Kingsway Hospitals, Nagpur, IND.
Cureus. 2023 Apr 5;15(4):e37185. doi: 10.7759/cureus.37185. eCollection 2023 Apr.
A retained foreign body (RFB) is a rare but possible complication of surgery. Among the most common retained foreign bodies are sponges, which may include lap pads and gauze pieces. Surgical never events are errors in medical care that are identifiable and preventable but have serious consequences for the patient, making it an important problem in terms of the safety and credibility of a healthcare facility. They also pose a major medicolegal threat to healthcare organizations and a diagnostic challenge for surgeons. Herein, we present the case of a 35-year-old woman who presented with signs and symptoms of acute intestinal obstruction. She revealed a history of Caesarean section 11 months prior. She had a stormy postoperative course then and had to undergo a diagnostic laparoscopy for pus aspiration three months after surgery, where no finding other than pus was reported. Upon presentation at our tertiary care center, she was examined and found to have an RFB for 11 months. She was managed surgically with successful laparoscopic removal of the gossypiboma and consequent resolution of all her symptoms. Though rare, the possibility of an RFB, especially after open surgery, should be kept in mind when diagnosing patients who present with pain, mass in the abdomen, or symptoms of an infection. Laparotomy is the mainstay of treatment for gossypiboma, but successful laparoscopic removal of the RFB provides a definite treatment with the super-added benefits of laparoscopy. Laparoscopic removal of gossypiboma has been reported in the literature and demonstrated in our tertiary care center.
异物残留(RFB)是一种罕见但可能发生的手术并发症。最常见的残留异物包括海绵,其中可能有剖腹手术用垫和纱布片。手术严重不良事件是医疗护理中的错误,这些错误是可识别和可预防的,但会给患者带来严重后果,这使其成为医疗保健机构安全和信誉方面的一个重要问题。它们也对医疗组织构成重大的法医学威胁,对外科医生构成诊断挑战。在此,我们报告一例35岁女性患者,她出现了急性肠梗阻的体征和症状。她透露在11个月前有剖宫产史。当时她术后病程波折,术后三个月不得不接受诊断性腹腔镜检查以抽吸脓液,当时除了脓液外未报告其他发现。在我们的三级医疗中心就诊时,检查发现她有异物残留11个月。她接受了手术治疗,成功地通过腹腔镜取出了棉籽瘤,所有症状随之缓解。尽管罕见,但在诊断出现腹痛、腹部肿块或感染症状的患者时,应牢记异物残留的可能性,尤其是在开腹手术后。剖腹手术是治疗棉籽瘤(包裹性纱布球)的主要方法,但成功地通过腹腔镜取出异物残留提供了一种明确的治疗方法,并具有腹腔镜手术的额外益处。文献中已报道过通过腹腔镜取出棉籽瘤,我们的三级医疗中心也有相关病例。