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Case Reports
. 2019 Apr 8;14(1):69.
doi: 10.1186/s13019-019-0889-8.

Intrapericardial gossypiboma found 14 years after coronary artery bypass grafting

Fatmir Caushi  1 , Lindita Çoku  2 , Ilir Skenduli  3 , Daniela Xhemalaj  3 , Arian Mezini  3 , Emira Hysa  3 , Francesco Rulli  4
Affiliations
Case Reports

Intrapericardial gossypiboma found 14 years after coronary artery bypass grafting

Fatmir Caushi et al. J Cardiothorac Surg. .

Abstract

Background: Foreign body left after surgery surrounded by a foreign body reaction otherwise known as gossypiboma, have been first described in 1884. Although it occurs rarely, it can lead to various complications which include adhesions, abscess formation and related complications. Intrathoracic gossypiboma is a rare but serious consequence of negligence, mainly during abdominal and cardiothoracic surgery that can lead to severe medical consequences. This paper aims to raise awareness among surgeons and nurses in the operating room to prevent such errors and future complications.

Case presentation: A patient with a history of coronary arterial bypass grafting performed 14 years ago, presented with shortness of breath and dry cough. A chest X-ray revealed a large mass in the left hemithorax. The chest CT demonstrated the presence of a heterogeneous density mass of 11 cm and smooth edges in the middle mediastinum, next to the heart and partially intrapericardial. Because clinical and radiologic evidence revealed presence of a mass, we did proceed with CT guided FNA of the mass. The cytology findings confirmed an inflammatory lesion. Based on patient symptomatology and the evidence of a mass, allegedly compressing the cardiopulmonary structures in vicinity, we performed surgical exploration. An old and degraded piece of surgical swap was found and removed through an anterolateral left thoracotomy. The post-operative course was excellent.

Conclusions: Forgetting surgical swaps during surgery is a medical fault. To avoid them, surgical units should design and implement a surgical inventory process to account for surgical instruments or surgical swaps. Failure to make a proper diagnosis of cases such as these can lead to further health complications in these patients. The iatrogenic foreign material seen as a mass in the radiologic films had not been previously noticed by other health professionals although the patient had undergone X-ray and cardiac ultrasound examinations in the 14 years following coronary bypass surgery. Once the causative agent was identified and removed the patient returned to normal activity.

Keywords: Gossypiboma; Intrapericardial; Surgery.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was requested and obtained from the Ethical Committee of University Hospital “Shefqet Ndroqi” of Tirana.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The Chest CT demonstrates a mass with smooth edges and heterogeneous density, next to the heart and partially intrapericardial
Fig. 2
Fig. 2
The view of the mediastinal mass after the left thoracotomy
Fig. 3
Fig. 3
The presence of an old and degraded piece of surgical swap intrapericardial
See this image and copyright information in PMC

References

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