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      A case of intra-abdominal textiloma mimicking a mesenteric tumor

      case-report

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          Abstract

          Introduction

          A textiloma or gossypiboma is a retained surgical material in the body after an operation. It may be asymptomatic or revealed by complications such as occlusion, perforation, and fistulization.

          Case report

          We report a case of intraabdominal textiloma mimicking a mesenteric tumor. The patient has a history of open cholecystectomy. She was referred to our department for the discovery on abdominal computed tomography scan (CT-scan) of a mass in the mesentery. A laparotomy was performed observing a textiloma which was resected with part of the small intestine. The evolution was satisfactory for the patient.

          Discussion

          Intraabdominal textiloma is the most frequently observed foreign body left after a surgical procedure. They can be asymptomatic or discovered incidentally for another cause. We describe two types of immune responses, tansudative and exudative response, depending on the antigenicity of the foreign body. Surgical resection is the gold standard of treatment.

          Conclusion

          Although they are rare, these foreign bodies can present real complications after an open surgery.

          Highlights

          • Textiloma is a retained foreign body left in the body after a surgical procedure.

          • It may remain asymptomatic or be responsible for real visceral complications.

          • Generally, the CT-scan facilitates the diagnosing process.

          • Surgery remains the mainstay of treatment for textilomas

          • It can be avoided by respecting the rules of the operating procedure, in particular the count of surgical sponges

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          Most cited references19

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          The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines

          The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons. Materials and methods: The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by e-mail. An online survey was completed to indicate their agreement with the proposed changes to the guideline items. Results: A total of 54 participants were invited to participate and 44 (81.5%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion. Conclusion: Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centred care.
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            Risk factors for retained instruments and sponges after surgery.

            Risk factors for medical errors remain poorly understood. We performed a case-control study of retained foreign bodies in surgical patients in order to identify risk factors for this type of error. We reviewed the medical records associated with all claims or incident reports of a retained surgical sponge or instrument filed between 1985 and 2001 with a large malpractice insurer representing one third of the physicians in Massachusetts. For each case, we identified an average of four randomly selected controls who underwent the same type of operation during the same six-month period. Our study included 54 patients with a total of 61 retained foreign bodies (of which 69 percent were sponges and 31 percent instruments) and 235 control patients. Thirty-seven of the patients with retained foreign bodies (69 percent) required reoperation, and one died. Patients with retained foreign bodies were more likely than controls to have had emergency surgery (33 percent vs. 7 percent, P<0.001) or an unexpected change in surgical procedure (34 percent vs. 9 percent, P<0.001). Patients with retained foreign bodies also had a higher mean body-mass index and were less likely to have had counts of sponges and instruments performed. In multivariate analysis, factors associated with a significantly increased risk of retention of a foreign body were emergency surgery (risk ratio, 8.8 [95 percent confidence interval, 2.4 to 31.9]), unplanned change in the operation (risk ratio, 4.1 [95 percent confidence interval, 1.4 to 12.4]), and body-mass index (risk ratio for each one-unit increment, 1.1 [95 percent confidence interval, 1.0 to 1.2]). The risk of retention of a foreign body after surgery significantly increases in emergencies, with unplanned changes in procedure, and with higher body-mass index. Case--control analysis of medical-malpractice claims may identify and quantify risk factors for specific types of errors. Copyright 2003 Massachusetts Medical Society
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              Retained foreign bodies after surgery.

              Medical errors during surgery are not well studied. To define risk factors associated with this type of error, we performed a case control analysis. We retrospectively reviewed medical records involving the ICD-9 code (998.4) for unintentional foreign object remaining in the body during surgery and incident reports gathered by the Department of Risk Management over a 10 year period from 1996 to 2005. Thirty cases were matched with at least four randomly selected controls (131 control patients) that underwent the same type of operation during the same time period. Thirty patients had retained foreign objects (52% sponges and 43% instruments). The abdominal cavity was most commonly involved (46%) followed by the thoracic cavity (23%) although no body cavity remained uninvolved. Eight patients required readmission (30%), 25 patients required reoperation (83%), and there was no mortality. When compared with controls, patients with retained foreign objects were more likely to have had a greater number of major surgical procedures at the same time (2.7 versus 1.8, P=0.004), to have multiple surgical teams (13% versus 2%, P=0.02), and more likely to have had an incorrect instrument/sponge count recorded (13% versus 2%, P=0.01). In multivariate analysis, factors associated with a significantly higher risk of retained foreign objects were the total number of major procedures performed [odds ratio 1.6; 95% confidence interval (CI), 1.1-2.3; P=0.008] and an incorrect count (odds ratio 16.2; 95% CI, 1.3-197.8; P=0.02). Retained foreign objects after surgery are associated with multiple major surgical procedures being performed at the same time and an incorrect instrument or sponge count. Identification of these risk factors using case-control analysis should influence operating room policy and reduce these types of errors.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                30 September 2024
                November 2024
                30 September 2024
                : 124
                : 110370
                Affiliations
                Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
                Department of Oncological Surgery, Regional Oncology Center, Mohammed VI University Hospital Oujda, Morocco
                Author notes
                [* ]Corresponding author. rhoulc@ 123456gmail.com
                Article
                S2210-2612(24)01151-9 110370
                10.1016/j.ijscr.2024.110370
                11471665
                39357479
                1d94f34d-0de2-43dd-8925-b10662bcef4d
                © 2024 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 August 2024
                : 23 September 2024
                : 28 September 2024
                Categories
                Case Report

                textiloma,foreign body,abdominal surgery,medicolegal implications,septic complications

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