Oblitos en Cirugía: análisis de casuística y estrategias para su prevención / Foreign body: case analysis and prevention strategies / Oblitos em Cirurgia: análise de caso e estratégias de prevenção

Introducción: El oblito es un evento de muy baja frecuencia pero que puede generar morbilidad grave. Si bien se han reconocido algunos factores de riesgo y desarrollado sistemas complementarios de detección, continua siendo un gran problema desde el punto de vista sanitario y médico legal. Objetivos: Analizar una casuística del Hospital Maciel, su forma de presentación y complicaciones. Pacientes y métodos: Se presentan 7 pacientes asistidos en los Servicios de Cirugía General y Urología del Hospital Maciel, en el período comprendido del 2013 - 2016. Las principales variables que se analizan son la forma de presentación y complicaciones, así como presencia de factores de riesgo. Resultados: El hallazgo fue de compresas en todos los pacientes. En 2 casos el oblito fue asintomático y en otros 4 sintomático. En los últimos, 2 tuvieron una presentación temprana y 2 tardía. El recuento de material fue incorrecto solamente en un caso. Ningún paciente falleció por las complicaciones resultantes. Discusión: El oblito en cirugía es un problema que seguirá existiendo en tanto existan los procedimientos quirúrgicos, por lo que es necesario hacer énfasis en el abordaje sistemático, existiendo también métodos auxiliares de diagnóstico que podrían comenzar a implementarse. Conclusiones: Encontramos casi sin excepción la presencia de factores de riesgo conocidos en nuestra serie, si bien el número de casos es reducido. También la incidencia impresiona ser algo más elevada de la señalada en la literatura.

Introduction: Retained foreign items are infrequent but can generate serious morbidity. Although some risk factors have been recognized and complementary detection systems developed, it continues to be a major problem from a health and medical legal point of view. Objectives: to examine a case study at Hospital Maciel, focusing on clinical presentation and complications. Patients and methods: 7 patients treated at the General Surgery and Urology Departments in Hospital Maciel, between 2013-2016. The main results analized are clinical presentation and complications, as well as the presence of recongnized risk factors. Results: In all patients, the foreign bodies were compresses. In 2 cases the foreign body did not elicit symptoms whereas in 4 cases it did. In the latter, 2 had an early and a late presentation. The material count was incorrect in only one case. No patient died from the resulting complications Discussion: Because retained surgical ítems will be a problem as long as surgical procedures are performed, it is necessary to emphasize on a systematic approach accompanied by complementary diagnostic tools that are also available in cases of item miscount. Conclusions: Risk factors were present almost without exception in our casuistry. Also, the incidence seems to be higher than that reported in the literature.

Introdução: Oblito é um evento de baixa freqüência, mas que pode gerar uma grave morbidade. Embora alguns fatores de risco tenham sido reconhecidos e desenvolvidos sistemas de detecção complementares, continua a ser um grande problema do ponto de vista da saúde e do direito médico legal. Objetivos: Analisar uma casuística do Hospital Maciel, sua apresentação e complicações. Pacientes e métodos: sete pacientes foram atendidos nos Serviços de Cirurgia Geral e Urologia do Hospital Maciel, no período entre 2013 e 2016. As principais variáveis analisadas são a apresentação e complicações, bem como a presença de fatores risco. Resultados: a descoberta foi de compressas em todos os pacientes. Em 2 casos, o oblito foi assintomático e em 4 casos foi sintomático. No segundo, em 2 a apresentação foi temprana e em 2 foi tardia. A contagem de materiais estava incorreta em apenas um caso. Nenhum paciente morreu pelas complicações resultantes. Discussão: o oblito em cirurgia é um problema que continuará a existir enquanto houver procedimentos cirúrgicos, por isso é necessário enfatizar a abordagem sistemática, e também há métodos de diagnóstico que podem ser implementados. Conclusões: encontramos quase sem exceção a presença de fatores de risco conhecidos em nossa série, embora o número de casos seja pequeno. A incidência também parece ser um pouco maior do que a relatada na literatura.

Surgical item left in the abdomen six years after abdominoplasty: case report / Corpo estranho retido cirurgicamente em abdômen seis anos após abdominoplastia: relato de caso

The retained surgical item in patients after closure of the wound is a situation that although rare is preventable and requires specific care such as institutional protocols for prevention. We report a case of removal of an already encapsulated pads by fibrin tissue (textiloma) from a patient six years after an abdominoplasty, which formed a palpable mass in her abdomen. The retained surgical items lead to variable symptoms such as palpable masses, compressions, non-absorptive loss and, sometimes, severe complications. The diversity of manifestations combined with their few frequency, most of the times, lead to underdiagnosis. Treatment should be individualized for each case, although in case of symptoms removal is indicated in most cases. Surgical removal is associated with complications as longer as objects remain in patient's body.

A permanência de corpos estranhos em pacientes após o fechamento da ferida operatória é uma situação que, embora rara, é evitável e demanda cuidados específicos como protocolos institucionais de prevenção. O caso relata a retirada de uma compressa já encapsulada por tecido de fibrina (textiloma) de uma paciente seis anos após abdominoplastia, formando uma massa palpável em seu abdômen. A permanência desses itens cirúrgicos leva a sintomas variáveis como massas palpáveis, compressões, síndromes disabsortivas e, algumas vezes, graves complicações. A diversidade de manifestações combinada a sua pouca frequência levam, muitas vezes, ao subdiagnóstico. O tratamento deve ser individualizado para cada caso, embora na presença de sintomas a retirada é indicada na grande maioria das vezes. A cirurgia de retirada está mais associada a complicações quanto maior tempo de permanência dos objetos no corpo do paciente.

Rare foreign bodies in oro-facial regions.

Accidental entry of foreign bodies into the oro-facial region could be due to trauma, therapeutic interventions or iatrogenic. Various foreign bodies and locations have been reported, for example, wood in the orbit, impression material in the maxillary sinus, tooth fragments in the orbit. All these cases presented with inflammatory reaction and formation of infected granuloma, pus discharging sinus and serious complications like intra-cranial abscesses. Foreign bodies sometimes migrate within the tissues and become symptomatic after a certain period of time. In these cases, it is very difficult to correlate the direct relation between the suspected foreign bodies with the present clinical symptoms. The removal of foreign bodies is often a surgical challenge due to a combination of difficulty in access and close anatomical relationship to vital structures. To prevent complications, foreign bodies should be diagnosed and removed on time.

case with a fistula draining into the stomach due to retained surgical gauze

Retained surgical gauze is occasionally observed in general practice. Herein, we report a case with surgical gauze retained for over 13 years that created a fistula which drained pus into the stomach

Intraluminal migration of Gossypiboma without intestinal obstruction for fourteen years.

A 55 years lady presented with dull aching right upper abdominal pain with intermittent episodes of diarrhea following cholecystectomy which she underwent fourteen years back. Ultrasound and computed tomography findings were suggestive of foreign body in right subhepatic space. Exploratory laparotomy revealed circumvented loop of ileum with intra luminal mass sized 5 x 10 cm, resection anastomosis of the segment of ileum was performed. When opened it contained a surgical sponge with no external communication but an internal fistulous tract was present between the proximal and distal loops beyond the mass. Though intraluminal migration of retained surgical sponge has often been reported, complete intraluminal migration without features of obstruction or external opening is rarely seen.

Corpo estranho intratorácico: achados radiológicos / Intrathoracic gossypiboma: imaging findings

Os autores relatam três casos de corpo estranho intratorácico, que é definido como uma massa de matriz de algodão, e geralmente se refere a compressa cirúrgica retida, uma rara complicação das cirurgias torácicas. Os pacientes foram examinados por radiografia de tórax e tomografia computadorizada,sendo os achados de imagem confirmados por toracotomia e estudo anatomopatológico. Os principais achados de imagem são de massas intratorácicas em pacientes com história de cirurgia prévia apresentando sintomas relacionados ao trato respiratório inferior em tempo variávelapós a intervenção cirúrgica. Foram analisados os principais achados de imagem dos três casos de corpo estranho intratorácico e correlacionados com revisão da literatura.

The authors report three cases of intrathoracic foreign body that is defined as a cotton matrix mass, mostly retained surgical sponge, a rare complication of a thoracic surgery. The patients wereevaluated by chest radiography and computed tomography with the imaging findings confirmed after thoracotomy and anatomopathological study. The mainly imaging findings consisted of intrathoracic masses in patients with previous thoracic surgery that return to hospital with lower respiratory tract symptoms in different period after surgery procedure. The three cases were related with a brief review of the literature.

Transmural Migration of Surgical Sponge Evacuated by Defecation: Mimicking an Intraperitoneal Gossypiboma

The spontaneous defecation of the surpical retained sponge is very rare. Here, we report a case of migrating surgical sponge that was retained in the colon and it was evacuated by defecation.

Transmural migration of a retained surgical sponge into the intestinal lumen: an experimental study.

A retained surgical sponge in the peritoneal cavity is an occasional misadventure in modern surgery. Such a sponge can migrate into the intestinal lumen, but its mechanism is still unknown. A piece of surgical sponge, measuring 4 x 4 centrimetres, was placed at different sites of the abdominal cavity of Wistar rats. Inspite of the absence of infection, entry of the sponge into the intestinal lumen was shown microscopically in 10 out of 36 rats. Parallel statistical analysis by Cutler-Ederer estimation was found to be 0.58 of condition probability at 6 months. Transmural migration of a retained surgical sponge was not only associated with different sites placing in the abdominal cavity (P = 0.680), but also whether a seromuscular incision was made or not (P = 0.306). A hypothesis, based on a study of microscopic and macroscopic pathology, is proposed as four stages: foreign body reaction, secondary infection, mass formation and remodeling.