Gossypiboma and “retained surgical items” (RSI).

This video shows Gossypiboma and “retained surgical items” (RSI).
This video shows Gossypiboma scanned after two years of surgery ( c-section ).
Gossypiboma, textiloma, or more broadly “retained surgical items” (RSI) is the technical term. The symptoms of gossypiboma are usually nonspecific and may appear years after surgery.
The ultrasound features of abdominal gossypiboma are divided into three types:- 1). An echogenic area with a strong posterior shadow. 2). A well-defined cystic mass containing distinct internal hyperechoic wavy, striped structures. 3). Non-specific pattern with a hypoechoic mass or a complex. Acoustic shadowing is observed in all cases. This occurs due to the attenuation of the beam by the foreign body as well as the presence of gas and sometimes calcification.
Gauze sponges are disposable medical supplies commonly used in medicine and surgery. They are ordinarily made of gauze and are used to absorb blood and other fluids as well as clean wounds. When used in surgery, they are called surgical sponges.
Potential consequences if a sponge is left in you after surgery.
Depending on the site where the sponge was left, consequences may include infections, obstructions, fistulas, internal bleeding, and other problems. The likelihood of these is increased by the fact that surgery sites are already especially vulnerable to inflammatory responses.
Intraoperative ultrasound is cost-effective in localizing and helps in retrieving lost surgical items.
The most common cause of gossypiboma is the retained surgical sponge. The patient is taken up for sonography which can reveal a linear echogenic area having a strong posterior acoustic shadowing.
Ultrasonography allows the identification of practically all types of gossypibomas, including imaging of retained surgical sponges in the abdomen and pelvis.
With the introduction of a newer and broader term “retained surgical items” (RSI), additional materials such as needles, broken instruments, irrigation sets, and rubber materials have been included in the conventional list.
With the advent of newer imaging modalities retained surgical items are now easily diagnosed by their characteristic imaging appearances. A combination of complementary imaging modalities helps to arrive at the diagnosis of this relatively rare complication. Factors contributing to their imaging features include the timing of diagnosis and imaging, presence of secondary infection, communication of the retained item with hollow viscous or external skin wound, and type of imaging modality used. A high index of suspicion is necessary for diagnosis before labeling it as a retained surgical item. In parallel with recent advances in surgery, it is essential that there is increasing awareness among radiologists regarding the newer types of retained surgical items.
The term gossypiboma is derived from the Latin word “Gossypium” meaning cotton wool, the suffix -oma meaning mass. Other terms used are “textiloma,” “gauzoma,” “muslinoma.” A suitable example of gossypiboma would be a mass-like reaction to surgical sponges that are accidentally left inside the patient during surgery.
Symptoms of Gossypiboma
Gossypiboma may present early with pain with or without lump formation or may remain asymptomatic for a long time with only vague symptoms. Patients may present with abdominal mass or subacute intestinal obstruction. Patients may rarely also present with fistula, perforation, or even extrusion per anus.

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