Gossypiboma: Retained surgical sponge after total abdominal
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Retention of surgical materials occurs after diverse surgical procedures, often times after counting of surgical materials pre and post operatively. A 45-year-old multiparous woman presented with an eight-week history of dysuria, fever, chills, frequency, nocturia, straining, feeling of incomplete emptying, urge incontinence and lower abdominal pain associated with a three-day history of protrusion of a whitish substance from the urethral orifice. A year ago she had undergone a total abdominal hysterectomy for bleeding uterine fibroids at a private clinic and had no symptoms until eight weeks before reporting to the clinic. Previous treatments for recurrent urinary tract infections were of no avail.

A cystogram done revealed a structure which resembled a surgical sponge situated between the bladder and vagina and an urethro-vaginal fistula was suspected as contrast outlined both the vagina and gauze during initial phase of contrast administration. An exploratory laparotomy done revealed adhesions between the bladder and the small bowel, and also an abdominal sponge that had invaded into the urinary bladder. On cystostomy the sponge was noticed to have extruded partially through the external urethra meatus. The sponge was removed, and the bladder repaired with vicryl 2/0. The post-operative management included oral antibiotics and the urethral catheter retained for 21 days. She was discharged home well and continent. She was reviewed at 2 and 6 weeks and was in satisfactory condition without any voiding difficulties...

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