Tiruneh Sileshi Genetu, Gashey Eneyew Mebratu, Aliyi Adem Ibrahim, Gelaw Litegebew Yitayeh
Department of Surgery, GAMBY General Teaching Hospital, Bahir Dar,Ethiopia.
Department of Surgery, GAMBY General Teaching Hospital, Bahir Dar,Ethiopia.
Int J Surg Case Rep. 2024 Nov;124:110377. doi: 10.1016/j.ijscr.2024.110377. Epub 2024 Sep 30.
Gossypiboma is retained surgical swab following any surgical procedure. Its diagnosis is usually difficult because of variable and nonspecific clinical symptoms. It is a serious but preventable surgical event. It continues to occur despite considerable patient safety efforts.
A forty-eight-year-old female patient presented with worsening abdominal pain, decreased appetite, and constipation associated with severe lower urinary tract symptoms. She had undergone appendectomy 10 months back and postoperatively she was having recurrent episodes of abdominal pain. Two months before her current presentation she presented with dysuria, urgency, and urge incontinence and she was diagnosed to have a bladder mass by ultrasonography and cystoscopy. Transurethral resection of bladder tumor was done but there was no symptomatic improvement. On physical examination, there was a right lower quadrant transverse surgical scar and suprapubic and right lower quadrant tenderness. Abdominal computed tomography (CT) scan showed focal bladder wall thickening and suprapubic intra-abdominal bubbly mass with minimal right lower quadrant collection. Exploratory laparotomy revealed a foreign body covered by adherent small bowel loops. Two perforations in the ileum were identified. Foreign body removal and segmental ileal resection and anastomosis were done. After the surgery, all symptoms disappeared.
Retained abdominal swabs remain a difficult challenge in current problem surgical practice. Clinical manifestation shows vast variation which relates to the location of the material within the abdomen. The clinical presentation is dictated by the type of foreign-body reaction.
Prevention is better than cure. Since the first report of a retained swab was by Wilson in 1884, there has been constant development of techniques and protocols to decrease its incidence. It is crucial to take all necessary measures to prevent its occurrence. Gossypiboma should be on the list of differential diagnoses if the patient has previous surgery.
棉拭子瘤是指任何外科手术后遗留的手术拭子。由于其临床症状多变且不具特异性，其诊断通常较为困难。这是一种严重但可预防的手术事件。尽管为患者安全付出了诸多努力，但此类事件仍时有发生。
一名48岁女性患者出现腹痛加重、食欲减退和便秘，并伴有严重的下尿路症状。她10个月前接受了阑尾切除术，术后反复出现腹痛。在本次就诊前两个月，她出现尿痛、尿急和急迫性尿失禁，经超声和膀胱镜检查诊断为膀胱肿块。进行了经尿道膀胱肿瘤切除术，但症状并无改善。体格检查发现右下腹有横向手术瘢痕，耻骨上区和右下腹有压痛。腹部计算机断层扫描（CT）显示膀胱壁局部增厚，耻骨上腹腔内有气泡状肿块，右下腹有少量积液。剖腹探查发现一个被粘连的小肠袢覆盖的异物。发现回肠有两个穿孔。进行了异物取出、部分回肠切除和吻合术。手术后，所有症状均消失。
在当前的外科手术实践中，遗留腹部拭子仍是一个难题。临床表现差异很大，这与异物在腹腔内的位置有关。临床表现取决于异物反应的类型。
预防胜于治疗。自1884年威尔逊首次报告遗留拭子以来，一直在不断开发技术和方案以降低其发生率。采取一切必要措施预防其发生至关重要。如果患者既往有手术史，棉拭子瘤应列入鉴别诊断清单。
