"Retained surgical items" or "RSI" is an unfortunate event
Efforts are in place to tackle the problem & yielding reduced incidence
To a large extent due to the awareness and meticulous manual or automated counting of the gauze & surgical instruments prior to closing the abdomen has reduced the incidence. However, such cases are also under reported.
Sometimes patients are asymptomatic and remains unnoticed. There are times despite patient being symptomatic, the diagnosis may be missed due to lack of awareness or inability to identity the foreign body because of subtle signs or when they are camouflaged by the bowel contents or gas.
Clinical input and high index of suspicion is important.
It is very important for the radiologists to recognize the various appearances
1. Metallic foreign bodies are easier to diagnose and can be easily picked upon X-ray like scissors.
2. Gauze pieces (gossypium or gossypiboma) can be very difficult do identity as they contain air within, confusing it with a bowel loop containing fecal matter. A trichobezoar may also have similar appearance.
3. Surgical packs which are used to control bleeding, have a radio-dense thread like marker in it.
Disclaimer: This blog is not to point out mistakes of our surgical colleagues. Had we been a surgeon, we could have been in a similar situation.
Further readings:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644334/
Posted by: Dr. Sharad Maheshwari
updated: 23.09.2022
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