Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review

Abstract

Although the incidence of retained surgical items (RSIs) is low, it is nevertheless an important preventable cause of patient injury that can ultimately lead to the patient's death and to subsequent high medical and legal costs. Unintentional RSI is the cause of 70% of re-interventions, with a morbidity of 80% and mortality of 35%. The most common RSIs are sponges or gauze (gossypiboma or textiloma), while retained surgical instruments and needles are rare. Perioperative counting of equipment and materials is the most common method of screening for RSIs, while a diagnosis can later be confirmed by the clinical appearance and by imaging studies. We present a rare case of a 43-year-old patient who was admitted to our hospital because of two retained needles following a cesarean section, despite several subsequent laparotomies. One needle had been removed previously, but in addition to the remaining needle, we also removed a retained gauze. The diagnosis of RSIs is extremely important, and safe surgical practices including the addition of new imaging technologies should be encouraged to detect RSIs.

Keywords: Retained surgical item; cesarean section; gauze; imaging; needle; surgery; surgical count.

Figure 1.

Retained needle on pelvic X-ray examination.

Figure 2.

Pelvic ultrasound showing a hyperechogenic 15 mm long structure at the junction of the uterine corpus and cervix.

Figure 3.

Pelvic ultrasound showing a structure of mixed echogenicity on the right side of the pelvis beside the uterus.

Figure 4.

Retained needle on X-ray examination using low-energy X-rays in the right lateral part of the cervix just below the uterine corpus.