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Retained Surgical Sponges (Gossypiboma)

Article  in  Asian Journal of Surgery · May 2005

DOI: 10.1016/S1015-9584(09)60273-6 · Source: PubMed

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 Original Article

Retained Surgical Sponges (Gossypiboma)

Kamal E. Bani-Hani, Kamal A. Gharaibeh and Rami J. Yaghan, Department of Surgery, Faculty of Medicine, King
Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan.

OBJECTIVE: Retained surgical sponges are seldom reported due to medicolegal implications. Awareness of this
problem among surgeons and radiologists is essential to avoid unnecessary morbidity. We present our experience
with this entity and review the related literature.
METHODS: The medical records of 11 patients who were diagnosed as having retained surgical sponges from
1990 to 2003 were reviewed.
RESULTS: The incidence was 1:5,027 inpatient operations. There were four males and seven females with a
median age of 45 years. The original operations were gynaecological (n = 4), general (n = 4), urological (n = 2) and
laminectomy (n = 1). In seven cases, the original operation was performed on an emergency basis. Five patients
were obese. A presumed correct sponge count was documented in eight cases. The median time between the
original procedure and diagnosis of retained sponges was 12 months. The tentative diagnosis was intestinal
obstruction (4 patients), urinary tract infection (1 patient), Crohn’s disease (1 patient) and tumour recurrence (1
patient). The correct diagnosis was suggested in the remaining four patients. Surgical removal of the retained
sponges was carried out in all cases except one, in which the patient passed the sponge spontaneously through the
rectum.
CONCLUSION: Retained sponges are more common in obese patients and after emergency surgery. A high
degree of suspicion is important for preoperative diagnosis. Despite the use of radio-opaque sponges and
thorough sponge counting, this moribund mishap still occurs. Although human errors cannot be completely
abolished, continuous medical training and strict adherence to regulations should reduce the incidence to a
minimum. [Asian J Surg 2005;28(2):109–15]

Key Words: gossypiboma, retained surgical sponge, retained surgical swab, textiloma

Introduction is generally appreciated.6 In the last 10 years, there have been

only a few reports in the literature concerning RS. In this paper,
Retained postoperative foreign bodies, of which sponges are we review our experience with this entity in order to increase
the most common, is a rare condition.1 This may be due to the awareness among surgeons and radiologists and, thus, avoid
reluctance to publish matters that can lead to medicolegal unnecessary morbidity, which is still being encountered.
implications or because it may initiate wide, critical press
coverage.2,3 The condition is sometimes called “gossypiboma” Patients and methods
because of the feared possibility of retained sponges (RS)
causing gossip about surgeons.4,5 Despite this rarity in re- From January 1990 to December 2003, 11 patients with RS
porting, RS appears to be encountered more commonly than were managed at the surgery departments of King Abdullah

Address correspondence and reprint requests to Dr. Kamal E. Bani-Hani, Department of Surgery, Faculty of
Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid – 22110, Jordan.
E-mail: banihani60@yahoo.com • Date of acceptance: 11 May 2004

© 2005 Elsevier. All rights reserved.

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 ■ BANI-HANI et al ■

University Hospital and its affiliated hospitals. These hospi-

tals are located in Irbid Province, which is the second largest
demographic area in Jordan, containing about 1.25 million
inhabitants. The military hospital in this area treats 35% of the
population, while the remaining 65% of the population are
treated by our University and affiliated hospitals. On average,
3,950 operations are performed at our hospital and its affili-
ates each year. In our operating theatres, we apply very well-
known standards that require the use of only radio-opaque
sponges, which should be counted once at the start and twice
at the end of all surgical procedures. If the count is incorrect,
then radiography or re-exploration is to be performed.
Patients’ clinical notes, radiological investigations, and
operative records were retrospectively reviewed. Data regard-
ing age, sex, the type of original operation, the interval between
the original operation and the diagnosis of RS, clinical pres-
entation, diagnostic work-up and the tentative diagnosis be-
fore identifying the RS were collected and analysed.

Results

The incidence of RS in our hospitals was 1:5,027 inpatient

operations. The Table details the characteristics of all the
patients. There were four males and seven females with a
median age of 45 years (range, 20–64 years). In seven cases Figure 1. Plain X-ray of the abdomen of Patient 9, who presented with
a palpable abdominal mass 23 months after emergency laparotomy
(63.6%), the original operation was performed on an emer- and splenectomy for a ruptured spleen following a motorcycle
gency basis. Five patients (45.5%) were obese. A presumed accident. Note the radio-opaque marker of the retained swab.
correct swab count was documented in the operative notes of
the original procedures in eight cases (72.7%). In the remaining was suspected in only four (36.4%) cases (Table; Patients 2, 6,
three cases (all emergency procedures), no documentation 9 and 10). The diagnosis was suggested by plain X-ray in
regarding swab count was found. Definitive diagnosis of RS Patients 2 and 9 (Figure 1), by barium enema in Patient 10

Table. Characteristics of the 11 patients with retained surgical sponges

Patient Sex Age (yr) Original operation Interval (mo) Clinical presentation Tentative diagnosis

1 F* 51 Hysterectomy† 148 Intestinal obstruction Adhesive obstruction

2 M 64 Laminectomy 108 Back pain Retained swab
3 F 38 Hysterectomy† 172 Abdominal mass Tumour recurrence
4 F 40 Hysterectomy† 112 Intestinal obstruction Adhesive obstruction
5 M* 49 Cholecystectomy 117 Intestinal obstruction Adhesive obstruction
6 F 20 Pyelolithotomy 113 Fever Retained swab
7 M* 22 Appendectomy† 115 Discharging sinus Crohn’s disease
8 F 43 Hysterectomy† 119 Intestinal obstruction Adhesive obstruction
9 F* 53 Splenectomy† 123 Abdominal mass Retained swab
10 F* 45 Appendectomy† 124 Abdominal mass Retained swab
11 M 62 Prostatectomy 112 Urinary retention Urinary tract infection

*Obese patient; †emergency surgery.

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examination revealed a vague, ill-defined, irregular, firm, non-

tender, mobile lump in the right iliac fossa with high-pitched
bowel sounds. Routine laboratory investigations were normal.
Plain abdominal X-rays and ultrasound examination were not
rewarding. Barium enema revealed a normal colon with an
irregular radiolucent intraluminal filling defect about 50 cm
proximal to the ileocaecal junction (Figure 2). The delayed
film showed a barium-coated cast of the lesion. Barium follow-
through examination was planned, but following the intake of
castor oil, the patient passed a 4 × 4 inch swab per rectum. The
terminal ileum was normal on X-ray and the patient’s symp-
toms disappeared. Barium follow-through examination 6

▼
Figure 2. Barium enema for Patient 10 reveals dilated ileal loops
with irregular radiolucent intraluminal filling defect (arrow) in the
terminal ileum.
Figure 3. Abdominal computed tomography scan for Patient 6,
who presented with wound infection and fever 3 months following
left pyelolithotomy. Note the hypodense mass with a thick periph-
(Figure 2) and by abdominal computed tomography (CT) in eral rim (arrowhead) and the characteristic appearance of a soft-
tissue mass with air bubbles and whirl-like patterns.
Patients 6 and 9 (Figures 3 and 4). The median time interval
between the original procedure and diagnosis of RS was 12
months (range, 2–108 months). All patients had morbidity as
a result of the RS, and no swab was found incidentally. There
was no mortality. In nine patients, the RS were removed by
open surgery (Patients 1–9). In Patient 10, the RS was passed
spontaneously through the rectum, while in Patient 11, the
RS was removed cystoscopically.
Patient 10 represents a rare event of RS with transileal
migration and spontaneous passage of the sponge through
the rectum. She was a 45-year-old obese woman who presented
with right iliac fossa pain that was associated with abdominal
distension for 6 months prior to admission. Her medical
history showed that she had undergone appendectomy at our
hospital 2 years before. The surgical record showed that the
appendectomy was difficult due to adhesions around the
Figure 4. Abdominal computed tomography scan for Patient 9.
caecum, but there was no concomitant bowel trauma. There Note the presence of a large rounded non-homogeneous mass
was no documentation regarding the swab count. Abdominal containing air bubbles with a mesh-like appearance.

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months later did not show any bowel abnormality. Over a In seven of our patients (63.6%), the original operations
24-month period of follow-up, the patient remained were performed on an emergency basis. Compared with ran-
asymptomatic. domly selected controls who underwent the same type of
operation during the same 6-month period, RS are nine times
Discussion more likely after emergency surgery, and four times more
likely when an unexpected change in the surgical procedure is
The incidence of RS in this study lies in the middle of reported undertaken.3 In our study, a presumed correct swab count was
figures.3,7–9 The incidence of RS is difficult to estimate because documented in eight patients (72.7%). In the remaining three
some patients remain asymptomatic and are never discovered, emergency procedures, no documentation regarding swab
and because of the lack of documentation of some diagnosed count was found. In the series of Gawande et al,3 sponge and
cases. However, the reported incidence varies between 1/1,000 instrument counts were performed in only 66.7% of cases and
and 1/3,000 procedures.7–9 Gawande et al report that the the counts were reported as correct for 88% of patients with
incidence of RS and retained instruments varies from 1/8,801 retained objects. Emergency operations are significantly more
to 1/18,760 inpatient operations at non-specialty acute-care likely to involve a failure to perform a count of sponges and
hospitals, corresponding to one case or more each year for a instruments. In such situations, disorganization is increased
typical large hospital.3 They suggest that these rates are under- so that it becomes more difficult to keep track of swabs and
estimated because they were calculated only on the basis of instuments.3 In one series reporting 29 cases of RS, a false
malpractice claims, and because the operations that form the correct sponge count was observed in 22 cases (76%), no
denominator for their calculation included large numbers sponge count was performed in three cases (10%), and false-
of procedures that were unlikely to result in RS.3 It has been negative intraoperative X-ray results were responsible for
estimated that more than 1,500 cases of retained foreign sponge retention in another three cases (10%). In the remain-
bodies occur annually in the USA.3 The occurrence of approxi- ing case, the sponge count was incorrect but the surgeon
mately one RS per year in our hospitals continues to be a declined to delay wound closure or obtain an intraoperative X-
source of significant morbidity with serious consequent medi- ray.6 In our opinion, emergency surgery is, to a large extent,
colegal implications. Despite the use of radio-opaque sponges performed by junior surgeons, who may underestimate the
and proper counting, the mishap continues to occur. The value of strict compliance with operating-theatre regulations,
problem lies in the human factor. No documentation of a adding to the higher incidence of RS. More involvement of
complete sponge count was found in the files of three patients. senior staff in emergency situations might reduce the inci-
Human errors cannot be abolished, but must be reduced to dence of RS.
a minimum. In this regard, strict adherence to operating- Five of our patients (45.5%) were obese. Patients with RS
theatre rules, continuous medical education for all personnel usually have a higher mean body mass index than controls.3 In
working in theatres, and the implication of failure to conduct addition to the huge amount of room in the abdomen of obese
punishments are the corner stones. At King Abdullah Teach- patients in which to lose a sponge or instrument, obesity may
ing Hospital, which is the largest hospital serving the area, increase the technical difficulty of the operation. This may
special quality assurance and operating-theatre committees place extra stress on the surgeon,3,14 and in addition to the fear
were recently established with clear written bylaws. of postoperative complications, surgeons may subconsciously
The female preponderance among this study group rush to finish their procedures as quickly as possible.14
was consistent with the experience of others. For example, RS may lead to serious consequences such as bowel or
Apter et al10 and Botet del Castillo et al11 report that RS is most visceral perforation, obstruction or fistula formation, sepsis
frequent after gynaecological procedures, followed by upper or even death.3,15 In the current report, RS resulted in severe
abdominal operations. Gawande et al report that 63% of their morbidity; four patients presented with intestinal obstruction
patients with RS were females, although patient gender was and one with a discharging sinus secondary to the RS. Ten
not a risk factor for RS in their study.3 Also, in keeping with the patients (91%) required re-operation to remove the RS and to
experience of others, nine of our cases occurred in relation manage its complications. The mean interval between the
to intra-abdominal procedures,12,13 while the remaining two original operation and the diagnosis of RS in our patients was
cases followed prostatectomy and laminectomy. For obvious 2.4 years. This is consistent with that reported by others.16
anatomical reasons, RS are rare after spinal surgery.12 The clinical presentation and the time interval between the

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original operation and diagnosis of RS are variable and depend ing the ileal wall. The sponge probably eroded into the termi-
on the location of the RS and the type of reaction RS can evoke. nal ileum and the defect in the bowel was sealed by adhesion to
Most commonly, aseptic fibrinous inflammatory reactions the anterior abdominal wall. As far as we know, this spontane-
and adhesions encapsulate the RS in omentum and nearby ous elimination of RS after ingestion of laxatives has not
organs. Accordingly, the diagnosis is difficult because of the previously been reported. Mason reported spontaneous pas-
less severe symptoms and the delay in onset from previous sage of RS per rectum,2 but unlike our case, the patient had
surgery. Patients usually remain asymptomatic and the RS are undergone laparotomy 6 days earlier and the sponge was
detected incidentally, or they present with pseudotumour milked from the terminal ileum to the caecum on the assump-
syndrome.7,17,18 In none of our patients was the RS found tion that the palpable intraluminal mass was solid faecal
incidentally, but in one patient, a tentative diagnosis of recur- material. Manabe et al also reported a case of spontaneous
rent tumour was suggested. In sharp contrast to this, in one expulsion of RS through the rectum.20 Crossen and Crossen
study, incidental discovery of intra-abdominal swabs was re- reported 37 cases in which the sponges were extruded into the
ported in 22 of 29 patients with RS.6 Kokubo et al report nine bowel and were passed by the rectum, 24 cases in which the
patients with RS, with an interval between the previous opera- sponges were found within the bowel at surgery and 10 cases
tion and CT ranging from 1 month to 18 years.16 None of their in which the sponges were found in the process of penetrating
patients had symptoms, although some had an asymptomatic the intestinal wall.26
abdominal mass. Although current surgical swabs are labelled with radio-
On the other hand, a cotton sponge may lead to an exuda- opaque markers, which facilitate their detection, the diagnosis
tive inflammatory reaction, with an abscess or chronic inter- of gossypiboma is not easy and a high index of suspicion must
nal or external fistula formation. This usually presents much be present. The markers may be distorted by folding, twisting
earlier than the fibrinous reaction sequel.10 The resultant or disintegration over time.5 The diagnosis was possible using
abscess and the pressure exerted by the foreign body may lead plain X-ray in only two of our patients. Moreover, even in the
to an external opening (as happened with Patient 7, who pres- presence of a radio-opaque marker, RS can be difficult to
ented with a discharging sinus in the right lower abdomi- visualize and may be overlooked, or an erroneous diagnosis
nal quadrant following appendectomy), or this may force an may be made.27,28 In one study involving 10 patients with RS,
opening into an adjacent adherent hollow organ such as the all the swabs had radio-opaque markers, but the diagnosis was
stomach, intestine, bladder, sigmoid colon or vagina (as hap- made by plain X-ray in only four patients, supplemented by CT
pened with Patient 10).4,10,19,20 A fold of sponge then pen- or ultrasound in two of these.11 Revesz et al reported that false-
etrates into the lumen of that organ, permitting the migration negative rates in detecting RS in an experimental study varied
of the swab into the organ lumen and leading to partial or between 3% and 25% according to the type of sponge used.27
complete intestinal obstruction or gastrointestinal haemor- This emphasizes, for both experienced surgeons and residents
rhage secondary to vessel erosion.4,11,17,18,21,22 The distal ileum in training, the importance of using only sponges that have
is the usual site of impaction, as in Patient 10. Internal extru- radio-opaque markers during surgical procedures, diligence
sion of RS has been reported to occur into all parts of the and accurate sponge counts before the procedure and both
intestinal tract, with the most frequent sites being the ileum before and after closure of the abdomen, and the need to
and colon.2 During this erosion process, which may take years, perform a methodical examination of the abdomen before
most patients are symptomatic and present with abdominal wound closure, especially in obese patients and during emer-
pain, nausea, vomiting, anaemia, an abdominal mass, diar- gency surgery.6,29 All measures should be taken to avoid RS.
rhoea, malnutrition, weight loss or intestinal obstruction.11,23,24 Some of the reported cases of RS appear to result from failure
Alternatively, the RS may be spontaneously expulsed per rec- to adhere to these standards.3
tum without any serious problems after a variable period of Ultrasound, CT scan or magnetic resonance imaging
10 days to 15 years. The peristaltic activity of the intes- (MRI)12,16,28,30 are usually necessary procedures, especially in
tine helps in propelling the foreign body.17,20,25,26 chronic cases, because the lesion may mimic a malignant
Patient 10 represents a rare event of RS, with transileal mass.9,31 They are valuable in facilitating the diagnosis in most
migration and spontaneous passage of the sponge through cases. CT usually reveals a hypodense mass with a thick pe-
the rectum. In this patient, the sponge took about 18 months ripheral rim. The characteristic appearance of a soft-tissue
following appendectomy to produce symptoms by penetrat- mass with air bubbles and a whirl-like or spongiform pat-

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 ■ BANI-HANI et al ■

tern10,16,32–35 is demonstrated in Figures 3 and 4. When no 10. Apter S, Hertz M, Rubinstein ZJ, et al. Gossypiboma in the early post-
operative period: a diagnostic problem. Clin Radiol 1990;42:128–9.
radio-opaque marker is seen on plain X-ray or CT scan, the
11. Botet del Castillo FX, Lopez S, Reyes G, et al. Diagnosis of retained
characteristic internal structure of the gauze granuloma is
abdominal gauze swabs. Br J Surg 1995;82:227–8.
best visualized on MRI.28 12. Van Goethem JW, Parizel PM, Perdieius D, et al. MR and CT imaging
Barium follow-through may show distorted or adherent of paraspinal textiloma (gossypiboma). J Comput Assist Tomogr 1991;
loops and grossly irregular mucosal patterns with segments of 15:1000–3.
13. Fernandez Lobato R, Marin Lucas FJ, Fradejas Lopez JM, et al.
narrowing and dilatation. In the presence of an intraluminal
Postoperative textilomas: review of 14 cases. Int Surg 1998;83:63–6.
sponge, as in Patient 10, a filling defect may be seen with 14. Couper RT. Risk factors for retained instruments and sponges after
retention of contrast material on the delayed films because of surgery. N Engl J Med 2003;348:1724–5.
contrast penetration into the sponge mesh. The bowel wall 15. Gonzalez-Ojeda A, Rodriguez-Alcantar DA, Arenas-Marquez H, et
expands around the barium-coated foreign body and the over- al. Retained foreign bodies following intra-abdominal surgery.
Hepatogastroenterology 1999;46:808–12.
all pattern closely resembles that of lymphosarcoma of the
16. Kokubo T, Itai Y, Ohtomo K, et al. Retained surgical sponges: CT and
small bowel.10,17,18 US appearance. Radiology 1987;165:415–8.
In conclusion, prevention of RS is far more important 17. Gupta NM, Chaudhary A, Nanda V, et al. Retained surgical sponge
than cure. Although RS is relatively rare, wide awareness of after laparotomy. Unusual presentation. Dis Colon Rectum 1985;28:
451–3.
this problem is mandatory to avoid unnecessary morbidity.
18. Serra J, Matias-Guiu X, Calabuig R, et al. Surgical gauze pseudotumor.
Early recognition and removal of the RS surgically, endo- Am J Surg 1988;155:235–7.
scopically4,36 or laparoscopically37,38 is necessary to prevent 19. Kato K, Kawai T, Suzuki K, et al. Migration of surgical sponge
most complications related to their presence. The results retained at transvaginal hysterectomy into the bladder: a case report.
depend on the timing of intervention. If the sponge is retained Hinyokika Kiyo 1998;44:183–5. [In Japanese]
20. Manabe T, Goto H, Mizuno S, et al. A case of retained surgical
for a long time, adhesions result in considerable morbidity
sponge penetrated into the sigmoid colon. Nippon Igaku Hoshasen
during the second operation. Despite the use of sponges with Gakkai Zasshi 1997;57:279–80. [In Japanese]
radio-opaque markers and thorough sponge counting, this 21. Fujita K, Ichikawa T. Encapsulated paravesical foreign body. J Urol
moribund mishap still occurs. Although human errors cannot 1990;143:1004–5.
22. Wig JD, Goenka MK, Suri S, et al. Retained surgical sponge: an
be completely abolished, continuous medical training and
unusual cause of intestinal obstruction. J Clin Gastroenterol 1997;24:
strict adherence to regulations should reduce the incidence to 57–8.
a minimum. 23. Dharamsi RD, Jesudason SRB, Rolston DDK. Chronic watery diar-
rhea due to a surgical pack in the ileal lumen. J Clin Gastroenterol
1990;12:239–41.
References 24. Risher WH, McKinnon WM. Foreign body in the gastrointestinal
tract: intraluminal migration of laparotomy sponge. South Med J
1. Williams RG, Bragg DG, Nelson JA. Gossypiboma – the problem of 1991;84:1042–5.
the retained surgical sponge. Radiology 1978;129:323–6. 25. Robinson KB, Levin EJ. Erosion of retained surgical sponges into the
2. Mason LB. Migration of surgical sponge into small intestine. JAMA intestine. AJR Am J Roentgenol 1966;96:339–43.
1968;205:938–9. 26. Crossen HS, Crossen DF. Foreign Bodies Left in the Abdomen: The
3. Gawande AA, Studdert DM, Orav EJ, et al. Risk factors for re- Surgical Problems, Cases, Treatment, Prevention: The Legal Problems, Cases,
tained instruments and sponges after surgery. N Engl J Med 2003; Decisions, Responsibilities. St. Louis: C.V. Mosby Co, 1940.
348:229–35. 27. Revesz G, Siddiqi TS, Buchheit WA, et al. Detection of retained
4. Mentes BB, Yilmaz E, Sen M, et al. Transgastric migration of a surgical sponges. Radiology 1983;149:411–3.
surgical sponge. J Clin Gastroenterol 1997;24:55–7. 28. Mochizuki T, Takehara Y, Ichijo K, et al. Case report: MR appearance
5. Abdul-Karim FW, Benevenia J, Pathria MN, et al. Retained surgical of a retained surgical sponge. Clin Radiol 1992;46:66–7.
sponge (gossypiboma) with a foreign body reaction and remote and 29. Lauwers PR, Van Hee RH. Intraperitoneal gossypiboma: the need to
organizing hematoma. Skeletal Radiol 1992;21:466–9. count sponges. World J Surg 2000;24:521–7.
6. Kaiser CW, Friedman S, Spurling KP, et al. The retained surgical 30. Nabors MW, McCrary ME, Clemente RJ, et al. Identification of a
sponge. Ann Surg 1996;224:79–84. retained surgical sponge using magnetic resonance imaging. Neuro-
7. Hyslop JW, Maull KI. Natural history of the retained surgical sponge. surgery 1986;18:496–8.
South Med J 1982;75:657–60. 31. Hemal AK, Singh I, Karan SC, et al. Retroperitoneal textiloma
8. Chorvat G, Kahn J, Camelot G, et al. The fate of swabs forgotten in following laparoscopic-assisted nephro-ureterectomy for lower
the abdomen. Ann Chir 1976;30:643–9. [In French] ureteric cancer, masquerading as a metastatic soft-tissue tumour.
9. Jason RS, Chisolm A, Lubetsky HW. Retained surgical sponge simu- Aust NZ J Surg 2000;70:467–8.
lating a pancreatic mass. J Natl Med Assoc 1979;71:501–3. 32. Choi BI, Kim SH, Yu ES, et al. Retained surgical sponge: diagnosis

114 ASIAN JOURNAL OF SURGERY VOL 28 • NO 2 • APRIL 2005

070/20
 ■ GOSSYPIBOMA ■

with CT and sonography. AJR Am J Roentgenol 1988;150:1047–50. 187–9.

33. Yamato M, Ido K, Izutsu M, et al. CT and ultrasound findings of 36. Altin M, Dobrucal A, Tuncer M, et al. Endoscopic diagnosis of a
surgically retained sponges and towels. J Comput Assist Tomogr 1987; retained surgical sponge following intra-abdominal surgery. Endos-
11:1003–6. copy 1995;27:467.
34. Liessi G, Semisa M, Sandini F, et al. Retained surgical gauzes: acute 37. Childers JM, Caplinger P. Laparoscopic retrieval of a retained surgi-
and chronic CT and US findings. Eur J Radiol 1989;9:182–6. cal sponge: a case report. Surg Laparosc Endosc 1993;3:135–8.
35. Parienty RA, Pradel J, Lepreux JF, et al. Computed tomography of 38. Hugh TB, Colman JV. Laparoscopic intraperitoneal foreign body
sponges retained after laparotomy. J Comput Assist Tomogr 1981;5: from adhesive drapes. Aust NZ J Surg 2000;70:525.

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