Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 7345  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (378 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed84    
    Printed0    
    Emailed0    
    PDF Downloaded3    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
CASE SNIPPET
Year : 2019  |  Volume : 65  |  Issue : 3  |  Page : 186-187

Forgotten gauze piece will not be forgiven always


Department of Urology, MIOT International, Chennai, Tamil Nadu, India

Date of Web Publication18-Jul-2019

Correspondence Address:
S Rajaian
Department of Urology, MIOT International, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_37_19

Rights and Permissions




How to cite this article:
Rajaian S, Pragatheeswarane M, Krishnamurthy K, Murugasen L. Forgotten gauze piece will not be forgiven always. J Postgrad Med 2019;65:186-7

How to cite this URL:
Rajaian S, Pragatheeswarane M, Krishnamurthy K, Murugasen L. Forgotten gauze piece will not be forgiven always. J Postgrad Med [serial online] 2019 [cited 2019 Aug 20];65:186-7. Available from: http://www.jpgmonline.com/text.asp?2019/65/3/186/262994




A 49-year-old female presented with persistent leakage of urine through vagina following hysterectomy for dysfunctional uterine bleeding. Vaginal and cystoscopic examination revealed 1 cm supra-trigonal vesico-vaginal fistula on the right posterior aspect of the bladder. She underwent laparoscopic repair of vesico-vaginal fistula. Vaginal packing was done at the end of the procedure. Her postoperative period was uneventful. Follow-up cystogram done at 2 weeks revealed wavy radio-opacity in the pelvis [Figure 1]. Oblique view during cystogram revealed that the radio-opaque marker was posterior to the bladder [Figure 2]. Her abdominal examination was normal. Her vaginal examination revealed a packed gauze piece in the vaginal apex. The forgotten gauze piece was removed from the vagina, and trial voiding was successful. We report this case to stress the need for a postoperative checklist and to question the routine use of vaginal packing.
Figure 1: Plain X-ray KUB shows wavy radio-opaque marker in the pelvis suggestive of retained gauze piece

Click here to view
Figure 2: Cystogram (oblique view) shows the location of gauze piece posterior to bladder

Click here to view


Intravaginal packing after vaginal reconstructive surgery is traditionally kept up to 24–48 h postoperatively.[1] Recent studies have contradicting recommendations regarding the continued practice of vaginal packing in the postoperative period.[1],[2] Vaginal packing helps in reducing postoperative pain but may not reduce the incidence of hematoma formation.[1] Vaginal packing can be safely omitted in most of the cases unless hemostasis is not satisfactory.[2] There is a high incidence of under-reporting of forgotten gauze piece because of the fear of litigation.[3] Gossypiboma in the pelvis may be located in the retrovesical space, bladder, or vagina.[3] Computerized tomography is indicated for accurate location of the forgotten gauze piece as X-ray and ultrasound might miss one which does not have a radio-opaque marker. Luckily in our case, as the gauze piece had a radio-opaque marker, it could be diagnosed on X-ray and removed before any complications could occur. Gossypiboma can be prevented by a meticulous count of surgical instruments and by use of gauze pieces with radio-opaque markers.[4] Although WHO surgical safety list is the standard of care,[5] postoperative checklist for removing vaginal pack before discharging the patient and thorough vaginal examination during immediate follow-up may help in reducing the incidence of a forgotten gauze piece.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Thiagamoorthy G, Khalil A, Cardozo L, Srikrishna S, Leslie G, Robinson D. The value of vaginal packing in pelvic floor surgery: A randomised double-blind study. Int Urogynecol J 2014;25:585-91.  Back to cited text no. 1
    
2.
Subramanya J, Curtiss N, Balachandran A, Duckett J. Should we use a vaginal pack to reduce blood loss at the time of prolapse surgery? Eur J Obstet Gynecol Reprod Biol 2016;206:181-3.  Back to cited text no. 2
    
3.
Mohammad MA, Chukwuemeka AL, Aji SA, Tukur J, Diggol GI, Ibrahim M. Intravesical migration of gossypiboma following vaginal hysterectomy: An unusual cause of acute urinary retention. Arch Int Surg 2014;4:176-9.  Back to cited text no. 3
  [Full text]  
4.
George AJP, Mukha RP, Kekre NS. Gossypiboma mimicking a retroperitoneal tumor. Urology 2014;84:e13-4.  Back to cited text no. 4
    
5.
Fudickar A, Hörle K, Wiltfang J, Bein B. The effect of the WHO surgical safety checklist on complication rate and communication. Dtsch ArzteblInt 2012;109:695-701.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow