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

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

Öz

Kaynakça

1. 1. Ramirez LF, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery 1989;25:226-30. [CrossRef]
2. 2. Okten AI, Adam M, Gezercan Y. Textiloma: A case of foreign body mimicking a spinal mass. Eur Spine J 2006;15 Suppl 5:626-9. [CrossRef]
3. 3. Karcnik TJ, Nazarian LN, Rao VM, Gibbons GE. Foreign body granuloma simulating solid neoplasm on MR. Clin Imaging 1997;21:269-72. [CrossRef]
4. 4. Ford LT. Complications of lumbar-disc surgery, prevention, and treatment. Local complications. J Bone Joint Surg Am 1968;50:418-28.
5. 5. Is M, Karatas A, Akgul M, Yildirim U, Gezen F. A retained surgical sponge (gossypiboma) mimicking a paraspinal abscess. Br J Neurosurg 2007;21:307-8. [CrossRef]
6. 6. Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR. Postoperative posterior spinal wound infections. Clin Orthop Relat Res 1992;284:99-108.
7. 7. Yamagami T, Matsui H, Tsuji H, Ichimura K, Sano A. Effects of laminectomy and retained extradural foreign body on cauda equina adhesion. Spine (Phila Pa 1976) 1993;18:1774-81. [CrossRef]
8. 8. Stoll A. Retained surgical sponge 40 years after laminectomy. Case report. Surg Neurol 1988;30:235-6. [CrossRef]

9. 9. Turgut M, Akyuz O, Ozsunar Y, Kacar F. Sponge-induced granuloma (“gauzoma”) as a complication of posterior lumbar surgery. Neurol Med Chir (Tokyo) 2005;45:209-11. [CrossRef]
10. 10. Atabey C, Turgut M, Ilica AT. Retained surgical sponge in differential diagnosis of paraspinal soft-tissue mass after posterior spinal surgery: report of eight cases. Neurol India 2009;57:320-3. [CrossRef]
11. 11. Kucukyuruk B, Biceroglu H, Abuzayed B, Ulu MO, Kafadar AM. Paraspinal gossybipoma: A case report and review of the literature. J Neurosci Rural Pract 2010;1:102-4. [CrossRef]
12. 12. Marquardt G, Rettig J, Lang J, Seifert V. Retained surgical sponges, a denied neurosurgical reality? Cautionary note. Neurosurg Rev 2001;24:41-3. [CrossRef]
13. 13. Akhaddar A. Boulahround O, Naama O, Al-boizidi A, Boucetta M. Paraspinal texiloma after Posterior Lumbar Surgery:A Wolf in sheep’s Clothing World Neurosurgery 2012;2:375-80
14. 14. Rajkovic Z, Altarac S, Papes D. An unusual cause of chronic lumbar back pain:Retained surgical gauze discovered after 40 years. Pain Med 2010;11:1777-9. [CrossRef]
15. 15. Erdem G, Ates O, Kocak A, Alkan A. Lumbar gossypiboma. Diagn Interv Radiol 2010;16:10-2.
16. 16. De Winter F, Huysse W, De Paepe P, Lambert B, Poffyn B, Dierckx R. High F-18 FDG uptake in a paraspinal textiloma. Clin Nucl Med 2002;27:132-3. [CrossRef]
17. 17. Kim HS, Chung TS, Suh SH, Kim SY. MR imaging findings of paravertebral gossypiboma. AJNR Am J Neuroradiol 2007;28:709-13.
18. 18. Matsuki M, Matsuo M, Okada N. Case report: MR findings of a retained surgical sponge. Radiat Med 1998;16:65-7.
19. 19. Gifford RR, Plaut MR, McLeary RD. Retained surgical sponge following laminectomy. JAMA 1973;223:1040. [CrossRef]
20. 20. Mathew JM, Rajshekhar V, Chandy MJ. MRI features of neurosurgical gossypiboma: Report of two cases. Neuroradiology 1996;38:468-9. [CrossRef]
21. 21. Hakan T, Aydoseli A, Demir K, Aker F. Clinical, pathological, and radiological features of paraspinal textiloma:Report of two cases and review of the literature. Neurol Neurochir Pol 2009;43: 475-8.
22. 22. Hyslop JW, Maull KI. Natural history of the retained surgical sponge. South Med J 1982;75:657-60. [CrossRef]
23. 23. Alander DH, Stauffer ES. Gelfoam-induced acute quadriparesis after cervical decompression and fusion. Spine (Phila Pa 1976) 1995;20:970-1. [CrossRef]
24. 24. Chater-Cure G, Fonnegra-Caballero A, Baldion-Elorza AM, JimenezHakim E. Gossypiboma in neurosurgery. Case report and literature review. Neurocirugia (Astur) 2009;20:44-9. [CrossRef]
25. 25. Naama O, Quamous O, Elasri CA, Boulahroud O, Belfkih H, Akhaddar A, et al. Textiloma: An uncommon complication of posterior lumbar surgery. J Neuroradiol 2010;37:131-4. [CrossRef]
26. 26. Aydogan M, Mirzanli C, Ganiyusufoglu K, Tezer M, Ozturk I. A 13-year-old textiloma (gossypiboma) after discectomy for lumbar disc herniation: A case report and review of the literature. Spine J 2007;7:618-21. [CrossRef]
27. 27. Yamato M, Ido K, Izutsu M, Narimatsu Y, Hiramatsu K. CT and ultrasound findings of surgically retained sponges and towels. J Comput Assist Tomogr 1987;11:1003-6. [CrossRef]
28. 28. Kopka L, Fischer U, Gross AJ, Funke M, Oestmann JW, Grabbe E. CT of retained surgical sponges (textilomas):Pitfalls in detection and evaluation. J Comput Assist Tomogr 1996;20:919-23. [CrossRef]
29. 29. Sakai T, Koh H, Matsuki A. A case of the foreign body due to “coring”. Masui 1996;45:1533-35.
30. 30. Taylor FH, Zollinger RW, Edgerton TA, Harr CD, Shenoy VB. Intrapulmonary foreign body:Sponge retained for 43 years. J Thorac Imaging 1994;9:56-9. [CrossRef]
31. 31. Topal U, Sahin N, Gokalp G, Gebitekin C. Intrathoracic textilomas:Radiologic findings (case report). Tani Girisim Radyol 2004;10:280-3.
32. 32. Rajput A, Loud PA, Gibbs JF, Kraybill WG. Diagnostic challenges in patients with tumors:Case 1. Gossypiboma (foreign body) manifesting
33. 30 years after laparotomy. J Clin Oncol 2003;21:3700-1. [CrossRef]
34. 33. Farina LA, Villavicencio H, Chechile G. Preoperatively recognized chronically retained pararenal gauzoma. Int Urol Nephrol 1995;27:33-5. [CrossRef]
35. 34. Van Goethem JW, Parizel PM, Perdieus D, Hermans P, de Moor J. MR and CT imaging of paraspinal textiloma (gossypiboma). J Comput Assist Tomogr 1991;15:1000-3. [CrossRef]
36. 35. Revesz G, Siddiqi TS, Buchheit WA, Bonitatibus M. Detection of retained surgical sponges. Radiology 1983;149:411-3.