Retained Surgical Gauze Swab Migration in a Paraplegic Patient: A Case Report and Literature Review

Introduction: Gossypiboma is a serious but uncommon complication of surgical interventions. Most case reports and reviews refer to abdominal or thoracic surgery. Retained postoperative foreign bodies in limb or spine surgery are less commonly encountered. We present a case of gossypiboma in a paraplegic patient originating from pararectal surgery and detected 15 years after index surgery for infectious migration to the left thigh. Case Presentation: A 56-year-old paraplegic patient with complete sensory deficit in both legs presented with signs of an infected haematoma at the left thigh. At the time of surgical evacuation cotton tissue originating from a surgical gauze swab was retrieved. After a thorough investigation of the patient’s medical history, polytrauma treatment consisting of emergent laparotomy with abdominal gauze packing in 1986 and surgical treatment of a fistulating pararectal abscess in 2001 were stated possible origins of the intraoperative findings. Further surgical interventions with a more extended approach were necessary. Another gauze tissue conglomerate was found next to the ischial tuberosity, revealing the surgical treatment of a pararectal abscess (developed from sacral decubiti) as the origin of the retained gauze swabs. Conclusion: Retained surgical gauze (RSG) swab is a serious and, due to medicolegal reasons, underreported complication of surgical intervention. Diagnosis can be challenging because patients may present with only vague symptoms. In the presented case, the patient remained asymptomatic for 15 years, mainly due to his paraplegia. Prevention of RSG is far more important than cure. Awareness of the problem, staff training and the use of preventive measures as radiopaque labelled gauze swabs or monitored counting should be mandatory in every surgical intervention.