Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

Year 2013, Volume: 2013 Issue: 4, 422 - 428, 01.04.2013

Soner Şahin Cem Atabey Mehmet Şimşek Sait Naderi

https://doi.org/10.5152/balkanmedj.2013.8732

Abstract

Background: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. Aims: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Study Design: Retrospective study. Methods: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. Results: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Conclusion: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes. Turkish Başlık Spinal Tekstiloma (Gossipiboma): Tümör Olarak Yanlış Tanı Konan Üç Olgu Sunumu Arkaplan: Cerrahide yaygın olarak kullanılan tekstil ürünlerinin (ör. süngerler veya gazlı bezler) spinal cerrahi sonrası komplikasyonlara neden olduğu bilinmektedir. İlişkili komplikasyonlar genellikle ilk ameliyattan aylar, hatta yıllar sonra ortaya çıkmaktadır. Omurga cerrahisi durumunda, bu cisimler genellikle bildirilen sırt ağrısını araştırmak için yapılan nöroradyolojik değerlendirmeler sırasında tespit edilir, bununla birlikte bu komplikasyon sıklıkla asemptomatik olarak kalmaktadır. Amaç: Araştırma hem spinal cerrahlar hem de nöroradyologlar arasında bu potansiyel komplikasyona farkındalığı artırmayı amaçlamaktadır. Çalışma Tasarımı: Retrospektif çalışma. Yöntemler: Bu çalışma, spinal tümör olarak yanlış tanı konmuş olan, cerrahi tekstil ürünleri kalmış üç hastanın retrospektif bir olgu serisidir. Hastaların tıbbi kayıtları incelendi ve demografik veriler, klinik yönleri, ilk tanı, cerrahi işlemler, önceki ameliyat ve semptomların başlaması arasındaki süre, laboratuvar bulguları, radyolojik bulgular, tedavi ve sonuçları analiz edildi. Bulgular: Üç hasta, yaşları 64 ve 67 yıl arasında olan iki kadın ve bir adamdan oluşmaktaydı. Tüm hastalar lomber disk hernisi için önceden ameliyat olmuştu. Önceki cerrahi işlemlerden başvuruya kadar geçen süre 3 ila 17 yıl arasında değişmekte idi. Tüm hastalar enfeksiyonun klinik bulguları olmaksızın radikülopati ve/veya non-spesifik bel ağrısı ile başvurdu. Bunun dışında laboratuvar parametreleri normaldi. Her üç olgu da manyetik rezonans görüntüleme bulgularına dayanarak bir spinal tümör olarak yanlış tanı almıştı. Yeni cerrahi işlemler sırasında, gazlı bezler, yani bir önceki işlem sırasında bırakılan cerrahi tekstil bulundu. Sonuç: Tekstiloma yıllarca asemptomatik kalabilen, önemli ve nadiren bahsedilen potansiyel bir nöroşirürji komplikasyonudur. Obez hastalarda, acil cerrahi sonrası sıktır ve cerrahi işlemde kanama gibi planlanmamış bir değişiklik ile birliktedir ve istenmeyen nöroşirürji komplikasyonlarıdır. Nöroradyolojik bulgular değişkendir ve non-spesifiktir; böylece, hastalar spinal tümör veya apse olarak yanlış tanı alabilir. Aynı şekilde, spinal cerrahi öyküsü olan hastalarda, spinal apse, hematom, hipertrofik skar, fibrosarkom, rabdomyosarkom ve şvannom kesinlikle ayırıcı tanıda düşünülmelidir ve tanı prosedürleri planlanırken dikkate alınmalıdır. Süpüratif komplikasyon mevcut veya şüpheli olduğunda uygun antibiyotik tedavisi önerilir. Tekstiloma bir mediko-legal komplikasyondur ve cerrahi personelin eğitimi, sayma yöntemi (preoperatif olarak, kapama sırasında ve sonunda) ve radyoopak barkodlu ürün kullanımı ile önlenebilir.

Keywords

Gauze bandage, spinal tumour, surgical textile products, lumbar spine, gossypiboma, foreign body granuloma

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

Abstract

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