Gastropleurobronchial fistula: lessons learned from delayed diagnosis of retained surgical sponge after abdominal surgery-A case report and review of the literature.

backgroundRetained surgical items pose a significant risk to patient's safety, with an estimated occurrence of 1 in 5500 procedures. Gossypibomas, also referred to as retained surgical sponges, are items unintentionally left in the cavities of the body after surgery. These adverse events can lead to secondary surgical procedures, readmissions, and infections. A 24-year-old Somalian male patient presented with persistent coughing, black sputum, and halitosis. His medical history included a laparotomy for a 5-year-old stab wound and penile amputation following a missile injury 15 years back. Physical examination revealed pale conjunctiva, pallor in the oral mucosa, and spoon-shaped fingernails. A chest X-ray demonstrated a ball-like consolidation in the lower left chest, and a thoracic computed tomography scan revealed a soft tissue lesion. The patient underwent thoracotomy and laparotomy, along with a left lower lobe lobectomy due to a bronchopleural fistula caused by a large abdominal surgical sponge invading the lung parenchyma, forming a cavitary lung mass. Diaphragmatic defect was repaired and resection of the gastric perforation using a stapler was performed. The patient's postoperative course was uneventful.

conclusionGossypibomas should be considered as a potential differential diagnosis in patients presenting with thoracoabdominal soft tissue masses and having a history of prior surgery. This is especially relevant in cases involving gynecological or emergency surgeries, female sex, or individuals with a high body mass index. A detailed medical history and appropriate imaging are essential for timely diagnosis.