Retained Surgical Gauze Presenting With Gross Hematuria: A Case Report Babak Javanmard, Mohammad Reza Yousefi, Behrouz Fadavi, Morteza Fallah Karkan * Keywords: Gossipyboma; prostatectomy; surgical gauze; gross hematuria. Urology department, Shohadaye Tajrish hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. *Correspondence: Urology resident, Urology department, Shohadaye Tajrish hospital, Shahid Beheshti University of Medi- cal Sciences, Tehran, Iran. Tel: +98-9111863352. E mail: Mortezafallah.md@gmail.com. Received October 2016 & Accepted June 2017 Gossipyboma is a mass which is made around a cotton sponge or abdominal compress retained in a patient during surgery accidentally. Patients manifest with either acute or chronic symptoms due to complications. Here in we reported an 89-year-old man case of transvesical migration of gossipyboma who presented with gross hematuria with a history of transvesical prostatectomy 6 years ago. Patient underwent exploratory laparotomy with repairing of the bladder and peritoneum. He had no complications during surgery and was subsequently discharged. INTRODUCTION Gossipyboma (textiloma, cottonoid, gauzoma, and muslinoma) is a mass which is made around a cotton sponge or abdominal compress retained in a patient during surgery accidentally(1,2). Its incidence during surgical procedures, reported in several case reports, is of about 1/1000–1500 procedures on average(3). Patients manifest with either acute or chronic symptoms due to complications. Each foreign body poses a challenge to the urolo- CASE REPORT Figure 1. Plain abdominal X-ray shows a retained surgical gauze (black arrow) in the abdominal cavity. Figure 2. Gross appearance of the retained gauze. Vol 14 No 05 September-October 2017 5027 Retained surgical gauze with gross hematuria-Javanmard et al. gist and treatment has to be individualized according to the size and its nature and age of the patient(4). Oth- er manifestations are either exudative like granuloma around the surgical sponge/gauze, abscess formation or aseptic complications such as adhesions or encapsula- tion months to years after surgery(5). Although open sur- gery is the most common approach in the treatment of Gossipyboma, endoscopic extraction or other minimal invasive surgery has also been reported(6-8). Herein we reported a case of transvesical migration of gossipybo- ma presented with gross hematuria. CASE DESCRIPTION An 89-year-old man was hospitalized with chief com- plaint of gross hematuria for 2 days. Physical exami- nation, showed a hypogasteric tenderness and firmness in abdomen. Laboratory findings were within normal limits. Other examinations were normal. He had a his- tory of open prostatectomy and bilateral hernioraphy at another hospital 6 years before admission. Computed tomography scan revealed a foreign body with heter- ogeneous margin in the pelvis that was surrounded by bladder tissue. Gauze retention in the posterior vesical fossa with migration into the bladder and peritoneal cavity was noted (Figure 1). Patient underwent exploratory laparotomy with repair- ing of bladder and peritoneum under spinal anesthesia. During operation, a Gossipyboma formation, about 8 cm in size, was noted with penetration into the bladder and abdominal cavity, The gauze was embedded in the granulation tissue surrounding the Gossipyboma. The gauze was removed successfully (Figure 2), and the penetrated bladder and abdominal fascia was repaired. There was no complication during and after surgery, and the patient was discharged after making an une- ventful recovery. DISCUSSION Leaving gauze or rarely instruments behind after any surgery is a misadventure and is solely iatrogenic(9). Swabs, packs, towels, or other instruments may be left in the body cavities after surgery(10). Rafique in a case series mentioned that 5 of 16 patients reviewed had re- tained surgical gauze (31.25%) in Pakistan(7). Gawande et al. found that the incidence of Gossipyboma and retained instruments varied from 1/8801 to 1/18760 of inpatient operations at general hospitals and it has been estimated that more than 1500 cases of retained foreign bodies occur annually in the USA(11). Change in operating room staff, an emergency operation, an unexpected change in procedure, inadequate number of staff, long duration operations, hurried sponge counts, inexperienced staff, patients’ unstable conditions, obe- sity of patients, excessive blood loss in trauma patients, and a failure to count surgical instruments and sponges are risk factors for leaving gauze or other instruments in body cavity (11,12). The three most important risk factors are emergency surgery, unplanned change in the opera- tion, and body mass index (2,13). Here we reported a Gossipyboma in vesical wall after prostatectomy which had been performed 6 years be- fore which manifested by gross hematuria. Nishikawa et al. reported a case of bladder tamponade caused by a foreign body (gauze) in the bladder of a 24-year-old man treated with the Lambotte wire and screw for repair of pubic bone fracture caused by traffic accident. Their case manifested after one year with gross hematuria(14). Plain abdominal radiography, sonography, fistulog- raphy, CT scan and MRI are useful for diagnoses(2,11). Time to presentation of Gossipyboma can be early or very late after surgery and with different manifesta- tions. Patients undergoing multiple abdominal surger- ies with chronic abdominal pain must undergo imaging including abdominal radiography which must be con- sidered carefully to see the surgical gauze line. In conclusion; although several cases of retained surgi- cal gauze have been reported previously, here we pre- sented a migration of gauze to urinary bladder which is rare and to our knowledge there is no previous re- ported case after prostatectomy. In our case, the chronic inflammation around the gauze made a Gossipyboma that rubbed out into the urinary bladder and presented as gross hematuria. Small symptom following surgeries even after many years should considered as an impor- tant clue to find the Gossipyboma. It is recommended that patients are followed up carefully to decrease later mismanagement and lower the rate of Gossipyboma. ACKNOWLEDGEMENT Patient Permission We took a written consent from patient to report his im- ages for promotion of knowledge. REFERENCES 1. Zantvoord Y, van der Weiden RM, van Hooff MH. Transmural migration of retained surgical sponges: a systematic review. Obstetrical & gynecological survey. 2008;63:465-71. 2. Erdil A, Kilciler G, Ates Y, et al. 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[Case report: a foreign body (gauze) in the bladder]. Hinyokika Kiyo. 1991;37:287-9. Retained surgical gauze with gross hematuria-Javanmard et al. Vol 14 No 05 September-October 2017 5029