Gossypiboma – “string of pearls” sign may be diagnostic: A case report

Abstract

Gossypiboma is a retained non-absorbable material composed of the common cotton matrix. It is an unexpected surgeon’s “never event” with serious medicolegal implications. We present a case of a young woman who came to our facility 6 days after an emergency cesarean section for prolonged labor in a private hospital with features in keeping with post-operative peritonitis. Pre-operative abdominal radiographs revealed bowel loops that were majorly gasless, except for a row of small round pockets of gas running horizontally across the right hemi-abdomen, giving the “string-of-pearls” sign. She was optimized for an emergency laparotomy. The intraoperative finding was a retained sponge walled off by loops of the dilated small bowel. Within this cavity was found 400 mL of pus. The sponge was removed with ease and the pus was drained with a good post-operative outcome. The finding of a gasless abdomen on a plain radiograph is a thing of concern as small bowel obstruction with or without bowel ischemia is the most feared cause of a gasless abdomen which can be life threatening. Therefore, a gossypiboma should always be considered in a post-surgical patient with abdominal radiographic findings of a gasless abdomen; in particular, with the “string-of-pearls” appearance present. This case highlights that retention of foreign bodies after surgery is a persisting “never event” and as such there is the need to comply with current recommendations on the prevention of retained foreign bodies. The most important approach to reducing the incidence of gossypiboma is prevention. Thus, awareness of this problem is mandatory to avoid unnecessary morbidities.