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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020
AFRICA
e7
case per 3 000 surgeries.
2
Emergent surgery has a greater risk of
gossypiboma than elective surgery.
3,4
Gossypiboma can occur in any part of the body with an inner
space but the most common location is the abdomen, followed by
the pelvis and thorax.
5
Thoracic gossypibomas tend to be found
in the lower third of the lung, with no difference in incidence
between the left and right lungs.
6
Pericardial gossypibomas are
much rarer.
Symptoms differ according to the size and site of the mass,
as well as the degree of inflammation. Abdominal gossypibomas
can cause abdominal pain and a palpable mass, whereas thoracic
gossypibomas often result in chest pain, non-productive cough
and fever.
7
Complications include adhesions, abscesses, fistulae
and perforations, which require a surgical approach to remove
the mass and control the inflammation. Despite the thoracic
gossypiboma, the patient in this case showed non-specific
symptoms such as abdominal pain and weight loss, probably due
to prolonged inflammation.
Most cases of gossypiboma are detected on a CT scan. CT
findings include well-encapsulated heterogeneous masses, often
with calcification, gas and spongy or textured fragments.
8
The
majority of masses does not exceed 10 cm in diameter and
usually involves the adjacent peritoneum, pleura or pericardium.
Magnetic resonance imaging findings are less accurate than
CT, and biopsy results are inconclusive as the mass consists of
foreign material and inflammatory tissue.
9
If a patient with a
history of previous surgery shows non-specific symptoms and a
CT scan reveals a mass at the operated site, a gossypiboma must
be suspected.
Conclusion
The rate of gossypiboma cases is declining,
10
however, since
it can occur during any surgery, a strict protocol for keeping
track of the materials used during surgery is needed. The use
of radiopaque gauze during surgery is one option to diagnose
gossypiboma quickly if prevention fails. After the disease is
diagnosed, surgical exploration and resection is the treatment,
and extreme care is needed to prevent a second gossypiboma
caused by the exploration itself. This case emphasises that
pericardial gossypiboma can cause non-specific symptoms such
as abdominal pain and weight loss, and can emerge after a long
time, over 30 years.
References
1.
Martins MC, Amaral RP, Andrade CS,
et al
. Características de imagem
na ressonância magnética de gossipiboma intracraniano: relato de caso
Fig. 3.
(A) Gross image of the mass. (B) Cross-section of the mass. (C, D) Contents of the mass: thrombus (asterisks) along with
gauze (arrows).
A
C
B
D