NDLI: Intrapericardial gossypiboma found 14 years after coronary artery bypass grafting

Content Provider	Springer Nature : BioMed Central
Author	Caushi, Fatmir Çoku, Lindita Skenduli, Ilir Xhemalaj, Daniela Mezini, Arian Hysa, Emira Rulli, Francesco
Abstract	Background Foreign body left after surgery surrounded by a foreign body reaction otherwise known as gossypiboma, have been first described in 1884. Although it occurs rarely, it can lead to various complications which include adhesions, abscess formation and related complications. Intrathoracic gossypiboma is a rare but serious consequence of negligence, mainly during abdominal and cardiothoracic surgery that can lead to severe medical consequences. This paper aims to raise awareness among surgeons and nurses in the operating room to prevent such errors and future complications. Case presentation A patient with a history of coronary arterial bypass grafting performed 14 years ago, presented with shortness of breath and dry cough. A chest X-ray revealed a large mass in the left hemithorax. The chest CT demonstrated the presence of a heterogeneous density mass of 11 cm and smooth edges in the middle mediastinum, next to the heart and partially intrapericardial. Because clinical and radiologic evidence revealed presence of a mass, we did proceed with CT guided FNA of the mass. The cytology findings confirmed an inflammatory lesion. Based on patient symptomatology and the evidence of a mass, allegedly compressing the cardiopulmonary structures in vicinity, we performed surgical exploration. An old and degraded piece of surgical swap was found and removed through an anterolateral left thoracotomy. The post-operative course was excellent. Conclusions Forgetting surgical swaps during surgery is a medical fault. To avoid them, surgical units should design and implement a surgical inventory process to account for surgical instruments or surgical swaps. Failure to make a proper diagnosis of cases such as these can lead to further health complications in these patients. The iatrogenic foreign material seen as a mass in the radiologic films had not been previously noticed by other health professionals although the patient had undergone X-ray and cardiac ultrasound examinations in the 14 years following coronary bypass surgery. Once the causative agent was identified and removed the patient returned to normal activity.
Related Links	https://cardiothoracicsurgery.biomedcentral.com/counter/pdf/10.1186/s13019-019-0889-8.pdf
Ending Page	4
Page Count	4
Starting Page	1
File Format	HTM / HTML
ISSN	17498090
DOI	10.1186/s13019-019-0889-8
Journal	Journal of Cardiothoracic Surgery
Issue Number	1
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2019-04-08
Access Restriction	Open
Subject Keyword	Cardiac Surgery Thoracic Surgery Gossypiboma Intrapericardial Surgery
Content Type	Text
Resource Type	Case study
Subject	Surgery Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine
Journal Impact Factor	1.5/2023
5-Year Journal Impact Factor	1.6/2023

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