CASE REPORT
Retained Foreign Body: ‘‘Needle in a Haystack’’ Lauren O’Brien, MD,* Kathleen M. Eyster, PhD,Þ and Keith A. Hansen, MDþ
Abstract: Retained foreign bodies remain an area of potential patient harm. This case describes a retained needle from distant surgery discovered at the time of the needle count after myomectomy. Key Words: retained foreign bodies, retained needle, fluoroscopy (J Patient Saf 2014;11: 228Y229)
U
nfortunately, postoperative complications are sometimes an unavoidable occurrence. In recent years, initiatives have been on the rise to develop protocols to ensure the number of medical errors be kept at a minimum. However, even with these established protocols, complications from medical errors can still occur. One such complication is that of the retained foreign body (RFB) or gossypiboma.1 The term gossypiboma refers to a mass of cotton matrix retained within the human body. This reference is commonly applied to the retained surgical sponge or towel, as it is the most common retained object reported, but the term has been used to describe needles and instruments as well. Other synonyms include textiloma, gauzoma, muslinoma, or cottonoid.2 The incidence of RFB varies widely from one case in every 1,000 to 10,000 procedures. However, most authors report an incidence ranging from 1 in 1,000 to 1 in 1,500 procedures.2Y4 It is suspected that a retained instrument, needle, or swab is often underreported. Reasons for underreporting are numerous, ranging from the fear of litigation and attracting unwanted attention to the institution, to the ‘‘near miss’’ where the error is corrected intraoperatively, to the still feared unrecognized cases that have yet to be discovered. For these reasons, the currently reported rates are suspected to be far lower than the actual rates.4,5 Although the established procedures of regular counting of all sponges and instruments, along with the increasing use of radio-opaque swabs, do prevent numerous errors each day, retained foreign body events continue to occur. We report a case of a retained needle from an appendectomy performed 28 years ago detected by an incorrect needle and sponge count during a second procedure.
CASE REPORT The patient is a 38-year-old woman with history of iron deficiency anemia due to menometrorrhagia secondary to uterine fibroids. On examination, she was discovered to have an enlarged, irregular-shaped uterus. Past surgical history is significant for an appendectomy performed 28 years before presentation. Preoperative pelvic ultrasound confirmed an enlarged uterus with From the *Department of Obstetrics and Gynecology, KU School of MedicineWichita, Wichita, Kansas; †Departments of Basic Biomedical Sciences and Obstetrics and Gynecology, and ‡Department of Obstetrics and Gynecology, Sanford School of Medicine of the University of South Dakota, South Dakota. Correspondence: Keith A. Hansen, MD, Department of Obstetrics and Gynecology, Sanford School of Medicine of The University of South Dakota, Health Sciences Center, 1400 West 22nd Street, Sioux Falls, SD 57105 (e
Retained Foreign Body: ‘‘Needle in a Haystack’’ Lauren O’Brien, MD,* Kathleen M. Eyster, PhD,Þ and Keith A. Hansen, MDþ
Abstract: Retained foreign bodies remain an area of potential patient harm. This case describes a retained needle from distant surgery discovered at the time of the needle count after myomectomy. Key Words: retained foreign bodies, retained needle, fluoroscopy (J Patient Saf 2014;11: 228Y229)
U
nfortunately, postoperative complications are sometimes an unavoidable occurrence. In recent years, initiatives have been on the rise to develop protocols to ensure the number of medical errors be kept at a minimum. However, even with these established protocols, complications from medical errors can still occur. One such complication is that of the retained foreign body (RFB) or gossypiboma.1 The term gossypiboma refers to a mass of cotton matrix retained within the human body. This reference is commonly applied to the retained surgical sponge or towel, as it is the most common retained object reported, but the term has been used to describe needles and instruments as well. Other synonyms include textiloma, gauzoma, muslinoma, or cottonoid.2 The incidence of RFB varies widely from one case in every 1,000 to 10,000 procedures. However, most authors report an incidence ranging from 1 in 1,000 to 1 in 1,500 procedures.2Y4 It is suspected that a retained instrument, needle, or swab is often underreported. Reasons for underreporting are numerous, ranging from the fear of litigation and attracting unwanted attention to the institution, to the ‘‘near miss’’ where the error is corrected intraoperatively, to the still feared unrecognized cases that have yet to be discovered. For these reasons, the currently reported rates are suspected to be far lower than the actual rates.4,5 Although the established procedures of regular counting of all sponges and instruments, along with the increasing use of radio-opaque swabs, do prevent numerous errors each day, retained foreign body events continue to occur. We report a case of a retained needle from an appendectomy performed 28 years ago detected by an incorrect needle and sponge count during a second procedure.
CASE REPORT The patient is a 38-year-old woman with history of iron deficiency anemia due to menometrorrhagia secondary to uterine fibroids. On examination, she was discovered to have an enlarged, irregular-shaped uterus. Past surgical history is significant for an appendectomy performed 28 years before presentation. Preoperative pelvic ultrasound confirmed an enlarged uterus with From the *Department of Obstetrics and Gynecology, KU School of MedicineWichita, Wichita, Kansas; †Departments of Basic Biomedical Sciences and Obstetrics and Gynecology, and ‡Department of Obstetrics and Gynecology, Sanford School of Medicine of the University of South Dakota, South Dakota. Correspondence: Keith A. Hansen, MD, Department of Obstetrics and Gynecology, Sanford School of Medicine of The University of South Dakota, Health Sciences Center, 1400 West 22nd Street, Sioux Falls, SD 57105 (e
