Gossypiboma – the retained surgical swab: An enduring clinical challenge

Ruvashni Naidoo, B Singh


Retained abdominal swabs remain a difficult problem. This review highlights the risk factors and index pathology, as well as markers that raise clinical suspicion, of a condition that may be elusive in presentation on account of its otherwise nonspecific signs and symptoms. A review of the English literature reporting retained abdominal swabs between 1992 and 2012 revealed 100 cases. Fifty-six percent of patients presented with pain, most commonly coupled with an abdominal mass or symptoms of bowel obstruction; 6% of patients presented with a fistula or a sinus; and 6% presented with extrusion of the swab; only 7% presented with signs indicative of sepsis. The most common initial surgery was obstetric and gynaecological (in 44% of cases); the second most common was general surgery (36%), most commonly following cholecystectomy. Plain abdominal X-ray was done in 45% of patients, followed by ultrasound, computed tomography (CT) scan or both. CT scan is the best preoperative diagnostic tool currently. The varying presentations exhibited by this postsurgical entity will continue to perplex the attendant practitioner. Clinical suspicion assisted by ultrasound and CT scan will improve definitive diagnosis. While there are many checkpoints to prevent this rare yet significant complication, human error and the unpredictability of surgery may make elimination impossible. The challenges presented with a retained swab, although rare, will persist, and with it the devastating consequences for both patient and clinician. Because of this, especially in the era of a litigious mindset, surgical vigilance and pre-emptive measures cannot be emphasised enough.

Authors' affiliations

Ruvashni Naidoo, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

B Singh, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Full Text

PDF (124KB)


Gossypiboma, textiloma, retained abdominal swab

Cite this article

South African Journal of Obstetrics and Gynaecology 2016;22(1):29. DOI:10.7196/sajog.1052

Article History

Date submitted: 2016-01-05
Date published: 2016-09-08

Article Views

Abstract views: 4439
Full text views: 1475

Comments on this article

*Read our policy for posting comments here

The South African Medical Association is the official publisher of the SAJOG.


                                        SOUTH AFRICAN MEDICAL ASSOCIATION

                                                         Events | Careers | CPD


The South African Journal of Obstetrics and Gynaecology| Online ISSN: 2305-8862 | Print ISSN: 0038-2329 | 

Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) | 

This journal is protected by a Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) | Read our privacy policy.

SAMA Journals: South African Medical Journal African Journal of Health Professions Education South African Journal of Bioethics and Law South African Journal of Child Health | Southern African Journal of Critical Care  | South African Journal of Obstetrics and Gynaecology | Undergraduate Research in Health African Journal of Thoracic and Critical Care Medicine  | Southern African Journal of Public Health