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| Year : 2019 | Volume
: 65
| Issue : 3 | Page : 186-187 |
Forgotten gauze piece will not be forgiven always
S Rajaian, M Pragatheeswarane, K Krishnamurthy, L Murugasen
Department of Urology, MIOT International, Chennai, Tamil Nadu, India
| Date of Web Publication | 18-Jul-2019 |
Correspondence Address:
S Rajaian
Department of Urology, MIOT International, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpgm.JPGM_37_19
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 |
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
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 | Figure 2: Cystogram (oblique view) shows the location of gauze piece posterior to bladder
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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 | |  |
| 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.  |
| 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. |
| 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. [Full text] |
| 4. | George AJP, Mukha RP, Kekre NS. Gossypiboma mimicking a retroperitoneal tumor. Urology 2014;84:e13-4. |
| 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. |
[Figure 1], [Figure 2]
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