|
Edited on Fri Aug-15-08 07:19 PM by WannaJumpMyScooter
Gossypiboma
answer in white... you know what to do
Discussion
Gossy is Latin for "gossypium" (aka cotton plant). "Boma" is Swahili for place of concealment. Surgical sponges, gauzes, and towels are the most commonly retained foreign bodies after surgery. The cotton is biologically inert and may stimulate either an acute inflammatory reaction or a chronic foreign body granulomatous reaction. When it stimulates an acute inflammatory reaction, it may incite an abscess, fistulae, erosion and (in the abdomen) perforation of adjacent viscera, draining sinuses, and fatal complications therefrom. It may also cause ileus secondary to adhesions. More often, however, the body reacts to the foreign substance with formation of an aseptic granuloma which may remain asymptomatic for many years. This aseptic granuloma has been alternatively referred to as a "gossypiboma" and a "cottonballoma". Cottonballomas are most often detected incidentally and should be considered in the differential of an abdominal mass in patients with a history of prior abdominal surgery. They may progressively enlarge over many years secondary to an indolent foreign body reaction with repetitive trauma and hemorrhage into the lesion.
Therapy: Resection if symptomatic
Radiology:
Plain film: May be normal or show a soft tissue mass (with radiopaque marker if one is present); a whorl-like appearance (secondary to gas trapped in fibers of sponge) is characteristic, but seldom seen.
Ultrasound: Most commonly see an echogenic area with strong, extensive acoustic shadowing; this shadowing may occur even in absence of air and calcification; shadowing is disproportionately large relative to extent of air or calcification; may alternatively see a complex mass, a hypoechoic mass or a cystic mass with irregular internal echoes.
CT : A low density, round, thick-walled mass is seen more often than a complex mass with areas of both low and medium density; rarely manifests itself as a high density mass; post-contrast, may see dense and prolonged rim enhancement reminiscent of abdominal abscesses and hematomas, thus history important for distinguishing between these entities; calcification is occasionally observed; while spongiform gas (equivalent to whorl-like pattern on plain film) is a more specific finding, it is seldom seen. The combined use of ultrasound and CT is helpful, along with the history, in making the diagnosis.
MR: T2-weighted images- characteristic "folded fabric" internal structure of gauze granuloma
Pearls:
* Surgical sponges, gauzes, and towels = most commonly retained foreign bodies status-post surgery
* May stimulate either an acute inflammatory reaction or a chronic foreign body granulomatous reaction cottonballoma (gossypiboma)
* Most often causes an aseptic granuloma which may remain asymptomatic for many years
* May enlarge over many years secondary to an indolent foreign body reaction with repetitive trauma and hemorrhage into lesion.
References:
Abdul-Karim FW, Benevenia J, et al. Case report 736. Skeletal Radiol. 21:466-9,1992.
Choi BI, Kim SH, et al. Retained surgical sponge: diagnosis with CT and sonography. AJR. 150:1047-50, 1988.
Kokubo T, Itai Y, et al. Retained surgical sponges: CT and US appearance. Radiology. 165:415-18, 1987.
Mochizuki T, Takehara Y, et al. Case report: MR appearance of a retained surgical sponge. Clin Radiol. 46:66-7, 1992.
Sexton CC, Lawson JP, et al. Case report 174. Skel Radiol. 7:211-13, 1981.
|
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
