Gossypiboma Resection after Eight Years in a Patient with Rheumatoid Arthritis and Diabetes

Abstract

Gossypiboma is the term used to refer to a mass formed by surgical material left in the body cavity after surgery. We present the case of a middle-aged woman with a history of rheumatoid arthritis controlled with corticosteroids and biologic therapies, uncontrolled type II diabetes mellitus, and cesarean section with postoperative bleeding eight years earlier, who presents with right lower quadrant abdominal pain and is found to have a gossypiboma from her previous operation. A subsequent operation is undertaken to remove the gossypiboma. After the procedure, our patient’s diabetes and chronic back pain greatly improve, raising the question of gossypiboma’s role in these diseases. A review of our patient’s records found that a correct sponge count was recorded after her cesarean section, raising questions about the operating room policies regarding surgical counts, the presence of falsely correct counts, and the need for postoperative plain films in procedures with an increased risk of a retained object. Our patient’s presentation eight years after the inciting surgery raises questions about the involvement her immunosuppressive therapy may have had in cloaking the gossypiboma. Our case also raises the question of surgical culpability, including the ethical and legal considerations for apology from the culpable surgeon.