Thinking beyond Gauze Count at Surgery: A Reminder to Surgeons on Textilomas

Introduction: Inadvertently leaving surgical sponges in operation site has been described by various terms, including textiloma and gossypiboma. In recognition of the morbidity and economic implications that are associated with this error, surgeons exercise utmost caution to avoid retention of surgical instruments in body cavities.
Presentation of Case: A 29 year old Para1 presented at our facility with incapacitating abdominal pain and swelling of twelve months duration. She had an emergency Caesarean section at another hospital one month before the onset her symptoms. She had several hospital admissions, during which she was managed conservatively for adhesive intestinal obstruction without sustained relief. She was resuscitated, and she had exploratory laparotomy at our centre. A surgical linen that measured 110x150cm was retrieved from an abscess cavity. The procedure was complicated by entero-cutaneous fistula, which was satisfactorily managed surgically.
Discussion and Conclusion: Despite the large size of the retained material, the diagnosis was not entertained for twelve months, thereby conferring untold hardship on the patient. The possibility of retained foreign bodies should be considered early as a differential diagnosis of chronic post-operative pain, abscess or fistula. Furthermore, teamwork and seamless communication between surgeons and other theatre staff is essential to prevent such mistakes.