THE MEDICO-LEGAL IMPORTANCE OF GOSSYPIBOMA (CASE REPORT)

Ulucay T, Dizdar MG, Yavuz MS, Asirdizer M.

4th Mediterranean Academy of Forensic Sciences Meeting, 14-18 October 2009, Antalya-Turkey. Poster Presentation. Abstract CD of Poster Presentations. 2009: 82-3.

ABSTRACT

Introduction: Retained surgical sponge or gossypiboma is rare but serious complication that may lead to medico-legal problems. The most common surgically retained foreign body is the laparotomy sponge. The incidence of gossypiboma is difficult to estimate because some patients remain asymptomatic and are never discovered. But it has been reported as 1 in 1000-1500 for all intraabdominal operations. Gossypiboma is a medico-legal problem especially for surgeons.

Case Report: We report a female case 22 years old with intraabdominal gossypiboma. She gave birth a child by cesarean section. After 7 months from this operation, she applied to Manisa State Hospital with prominent pain at the left side of abdomen and diarrhea. In the medical examination, a mass was determined in the epigastrium. In the CT the mass was retroperitoneal and the patient was transferred to the University Hospital. In this hospital, a firm, fixed and smooth mass with 5 cm diameter was palpated during physical examination. In the abdominal CT, it was defined that there was a massive lesion with dimensions 6cm x5cm x4cm in left lateral of the umbilical plane, settled on anterior of colon descendence, infiltrated to layer and lumen of colon, and prediagnosis was “gossypiboma”.  In the surgical operation a mass with 15 cm diameter was seen on the sigmoid colon, above 20 cm of peritoneal deflection. The curve of ileum entered into this mass at 70 cm proximal of ileocecael valve and there were extensive adhesions around the mass.  The foreign body had entered into the sigmoid colon after fistulisation in small intestines and colon. This foreign body was confirmed as a surgical sponge pathologically.

Discussion: During trial about the surgeon, the above mentioned case was sent to the department of forensic medicine for medico-legal evaluation. In the medico-legal report this foreign body was decided as a life-threatening situation for patient.

Conclusion:  Gossypiboma is one of the significant medico-legal problems needs to be solved by specialists of forensic medicine.