Journal of Postgraduate Medicine
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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

Correspondence Address:
S Rajaian
Department of Urology, MIOT International, Chennai, Tamil Nadu
India




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;65:186-187


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 2022 May 17 ];65:186-187
Available from: https://www.jpgmonline.com/text.asp?2019/65/3/186/262994


Full Text



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}{Figure 2}

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

1Thiagamoorthy 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.
2Subramanya 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.
3Mohammad 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.
4George AJP, Mukha RP, Kekre NS. Gossypiboma mimicking a retroperitoneal tumor. Urology 2014;84:e13-4.
5Fudickar 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.

 
Tuesday, May 17, 2022
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