Stephen J. Birchard DVM, MS, Diplomate ACVS

Sunday, November 24, 2013

Here Is What Happens When You Leave a Surgical Sponge in the Abdomen

Fig. 1
Fig. 2

Case Report

Penny is a 5-year-old female spayed mixed breed dog that presented with a chronic draining tract on her left flank. (Fig. 1-2) The track had been present for 1 year and had been operated 3 times with no resolution. Each time the exploratory surgery was performed directly over the affected area of the flank attempting to follow the tract to its source. No foreign body or other etiology was found on any of the previous surgeries. Repeated antibiotic therapy would temporarily stop the drainage; cessation of the antibiotic would result in recurrence of the drainage. Other than the tract no significant abnormalities were found on physical examination.

Plain film abdominal radiographs were unremarkable. A positive contrast fistulogram was performed by inserting a Foley catheter into the tract and injecting water-soluble radiographic contrast material.(Fig. 3) Although a foreign body was not outlined it appeared that the contrast entered the abdominal cavity.
Fig. 3

Because of the suspicion of an intra-abdominal foreign body, a ventral midline laparotomy was performed. A large, adherent, firm granuloma was present in the left dorsal caudal abdomen adjacent to the urinary bladder and descending colon and adhered to the left ureter. (Fig. 4) 
Fig. 4: Granuloma in caudal abdomen (arrow)
After tedious blunt and sharp dissection that extended deep into the epaxial muscles, the granuloma was excised. Inside the granuloma was a surgical sponge. (Fig. 5)
Fig. 5: Surgical sponge found in the center of the granuloma.
Penny had an unremarkable recovery from anesthesia and surgery. The tract resolved and did not recur.

The only abdominal surgery Penny had was when she was spayed as a puppy. The sponge was present in her for 5 years.

In the next blog we’ll talk about how to prevent this from happening.