For nearly a year, a 48-year-old woman experienced recurrent lower urinary symptoms. The symptoms first appeared a few weeks after she had an abdominal hysterectomy. A scan revealed a surgical towel and a pair of hemostats inside of the patient. These items led to a fistulous connection between the ileum and the dome of the urinary bladder. The recurrent urinary tract infection was due to contamination of the urinary bladder with content from the small intestines seeping through the abdominal textile.
In 2017, a California man underwent surgery to remove damaged blood vessels in his abdomen and groin. Ten days later, the man died of cardiac-respiratory arrest. A postmortem x-ray revealed that a surgical sponge had been left in the man’s abdomen. An autopsy later suggested that the man’s death had been caused by several things, including peritonitis prompted by the sponge’s prolonged presence in the patient’s body,
Retained Surgical Items (RSI)
The term retained surgical item refers to any surgical sponge, instrument, tool, or device that is unintentionally left in the patient at the completion of a surgery or other procedure. According to the Joint Commission, an item is considered retained if it is discovered any time after completion of the skin closure, even if the patient is still in the operating room or under anesthesia. The term “retained foreign body” is sometimes used in place of “retained surgical item”. However, the former term includes other objects such as shrapnel.
The precise number of RSI occurrences is unknown. However, studies indicate that some 1,500 to 2,000 patients have a foreign item left in their body after surgery each year.
Common RSIs
There are often a wide array of supplies, tools, instruments, or other objects in use in the operating room. Many are used in close proximity to the patient’s body. They can fall inside or be left inside by mistake. Examples of RSIs include:
- blades
- clamps
- clips
- cotton swabs
- drains
- electrodes
- forceps
- gauze
- hemostats
- needles
- pins
- retractors
- scalpels
- scissors
- sponges
- suction tips
- surgical gloves
- surgical masks
- towels
- tubing
Sponges are the most common RSI, accounting for nearly 70% of all objects left inside patients after surgery. Dozens of surgical sponges can be used during an extensive procedure. When soaked in blood, these relatively small items can be difficult to distinguish from surrounding tissues.
Locations of RSIs
RSIs are commonly located in the abdominal cavity. However, they can be found elsewhere, including the tracheobronchial tree, retroperitoneal space, and uterus.
Symptoms of RSIs
Clinical presentation of RSIs is varied, leading to avoidable morbidity. The side effects can manifest immediately after the surgery or even years afterward.
Abdominal pain is the most common symptom associated with RSIs. Other symptoms may include:
- chest pain
- old and clammy skin
- constipation
- coughing or vomiting blood
- digestive problems
- fever
- headache
- lightheadedness
- loss of consciousness with no visible cause
- nausea
- pelvic pain
- swelling
- weight loss
These conditions can be symptomatic of many problems, making it difficult to identify the correct cause.
Dangers of RSIs
Retained surgical items put patients at risk of a wide range of medical problems, including internal bleeding, obstructions, infection and permanent disability related to the removal of infected organs.
If you believe you or a family member has been injured due to a retained surgical item, call Comitz Law at 570-829-1111 or email info@comitzlaw.com. We can help you.