Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, December 5, 2013

4 Ways to Avoid Leaving a Sponge in the Abdomen of a Dog, and Look What Else Someone Left In!

1. Count! Do a sponge count before and after the surgical procedure. If there is a discrepancy, search the surgical site for the sponge. If no sponge is found, obtain a postoperative radiograph to determine if a sponge is retained (see item #2).
Fig. 1: Ray-tek 4 X 4 sponges on the left have a radiopaque line in them (the blue material)
Larger laparotomy sponges on the right have a blue radiopaque ribbon on them. 
2. Use Ray-tek sponges. They have linear radiopaque material in them so that the sponge can be easily seen on radiographs. (Fig. 1)
Fig. 2: A sponge left in a dog during a spay. Bowel and mesentery are adhered to the sponge
making removal difficult.
3. Never pack an entire sponge in a body cavity. As the sponge absorbs blood and other fluids it blends in with the tissues and becomes almost invisible. (Fig. 2) Always leave part of the sponge outside of the cavity, or attach a forcep to it and keep the forcep outside of the cavity.

4. Use laparotomy sponges. (Fig. 1) These large, very absorbent sponges are a better choice than 4 x 4 sponges for packing off organs in the abdomen or thorax. A blue radiopaque ribbon is attached to them that can be left outside of the body cavity. Having said this, I have seen these left in the abdomen as well. Count them before and after the surgery also.
Fig. 3: Abdominal radiograph of a 4 year old female St. Bernard that was
spayed as a puppy.
Sponges are not the only things left in patients. (Fig. 3) The radiograph is a St. Bernard I operated many years ago at the Animal Medical Center in New York City. The dog had been spayed several years earlier. The dog presented to us for vomiting and abdominal pain. On abdominal exploratory, a section of bowel mesentery had become entrapped and strangulated in one of the rings of the forceps. The forceps were rusted and broken. Intestinal resection and anastomosis was necessary.

Establish protocols for all surgical procedures to prevent mistakes. Although they seem tedious, they are necessary to avoid complications and resultant patient morbidity.

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