5 abnormal cases of retained foreign bodies in patients

20161214130000, Brenda Lau, Luke Anthony Tan
Retained surgical items happen once in every 5,500 to 7,000 surgeries.
Retained surgical items happen once in every 5,500 to 7,000 surgeries.
Surgeries involve a wide variety of supplies, tools, and instruments in the operating room. Of which, some may be used near the patient’s body and can fall inside or be left inside by mistake.

Although these instances of “retained surgical items” are rare, they take a toll on the physical and mental health of the patient.

1. Surgical clamp trapped, twice, inside a man’s abdomen

A single incident of an RFB (Retained Foreign Body) is hazardous on both physical and mental health. However, a 59-year old male patient who had already undergone several surgeries, experienced it twice. Embedded in his abdominal area, was a surgical clamp, six inches long and due to his multiple surgeries, doctors do not know how long the clamp has been inside the man.

The man sought professional advice as he complained of nausea and mild abdominal pain. After several test, the source was found to be a metal clamp trapped in his abdomen behind the liver. This was the second clamp that was stuck in the man's body.

The first clamp was left in year 2000, after an intestinal operation was performed in another hospital. It resulted in an infection eight months later and the clamp was removed by the surgeon who left it. It is believed that the second clamp was likely to have been left behind when the first one was found. Perhaps the medical team should recount their medical instruments.

2. Large surgical sponge retained, thought to be a tumour

Four weeks after giving birth, a 28-year-old woman sought consultation for a strange abdominal pain she was feeling. An ultrasound scan was performed and the doctors did not find any abnormalities. However, the pain worsened six months later and became persistent, urging her to get examined again.

This time, a mass in her stomach was found and it was affecting part of her small intestine and right colon, along with large local lymph nodes and an immediate removal of the "tumour" was ordered. But it turned out to be a case of gossypiboma, or retained surgical sponge.

Upon incision, approximately two litres of oozing yellowish pus and fluid, and a large surgical sponge were found in an inflamed cavity wall.

3. Woman passes out one grip of surgical forceps inside her

After three years from an operation for hydatid cyst in a liver of a 36-year old female patient, she discovered that she had retained the surgical forceps they used during the surgery in her body . She passed out one of the grips of the metal instrument through her stool while she was defecating.

She had been in pain for the past three years, but brushed it off until she decided to visit the hospital and a radiological image of her abdomen confirmed the presence of the surgical instrument. She was fortunate enough that no signs of pathologic reaction were evident inside her abdomen when the forceps were removed - as the "single-gripped" forceps had already corroded and turned black.

4. Blade stuck in man's skull for four years

Not all RFBs are due to a surgeon's malpractice. Li Fu, a 37-year old Chinese resident was stabbed in the head with a 4-inch knife blade in an armed robbery back in 2006.
He received treatment for his injuries, but the knife in his head was overlooked and his wound healed over the knife. The man complained of severe headaches to doctors afterwards and many brushed it off as chronic migraine - without valid reason.

It took them four years before they took a radiograph image of his skull and to their surprise, they found the blade embedded in his skull. Li Fu was immediately admitted for surgery to remove the sharp object in his head.

This highlight how doctor-patient communication is vital in dealing with patient's medical conditions, as a poor medical assessment may lead to negligence.

5. Asepto bulb left in vagina, causes intestinal motility

A female patient underwent a robot-assisted surgery whereby her uterus, ovaries, fallopian tubes and appendix had to removed as she was suffering from severe and chronic pelvic pain. Doctors removed her uterus and cervix transvaginally, and an Asepto bulb - without the syringe - was inserted into the vagina with a trocar to access her abdomen.

On the fourth day after discharge, the patient returned to the hospital complaining of fever, chills, abdominal pain, nausea and vomiting. Laboratory tests suggested a kidney infection but a CT scan revealed a ring-like object in her vagina, which was thought to be a form of contraception.

Upon vaginal examination, the Asepto bulb was discovered in her vagina and was consequently removed. She was then discharged with an antibiotic prescription. However the next day she returned, complaining of nausea and vomiting as she could not tolerate an oral intake.

Due to the vaginal RFB, the added pressure to the bladder neck caused partial bladder obstruction and urinary tract infection. She ultimately suffered from intestinal motility after surgery.

Surgical teams to tighten procedures

According to various studies, retained surgical items happen once in every 5,500 to 7,000 surgeries. And as a result of surgical items being left behind, the patients suffer the most.

“In most instances, the patient is completely helpless,” said Dr Gibbs, the director of NoThing Left Behind, a notional surgical patient safety project. “We’ve anaesthetised them, we take away their ability to think, to breathe, and we cut them open and operate on them. There’s no patient advocate standing over them saying, ‘Don’t forget that sponge in them.’ I consider it a great affront that we still manage to leave our tools inside of people.” MIMS

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Sources:
http://www.lifehack.org/484834/10-most-horrific-cases-of-foreign-bodies-left-inside-a-patient
http://well.blogs.nytimes.com/2012/09/24/when-surgeons-leave-objects-behind/?_r=1