Retained Foreign Body, Still a Reality and Consequence of Non-use of the WHO Surgical Safety Check Lists in Tropical Surgery

Abstract

Adhesions are a major cause of acute abdomen in previously operated patients. The presence of a retained foreign body in the abdomen is a leading factor in the development of post-operative adhesion. It is, therefore important to take all necessary measures to avoid retained foreign bodies in the abdomen, as this increases the risk of developing post-operative adhesions and complications. A 32yr old female with a relevant past surgical history of an emergency laparotomy indicated for a ruptured ectopic pregnancy presented as an emergency 3 months after the above surgery at a tropical regional hospital with signs of generalized peritonism, following a brief history of sudden onset of lower abdominal pains. A diagnosis of bowel obstruction was made. Resuscitation was done, followed by an emergency exploratory laparotomy. It revealed the presence of a retained foreign body (gauze in our case), surrounded by multiple adhesion around the ileo-cecal junction with 2 meters of ischemic small bowel. Adhesion lysis was done, foreign body was extracted, the ischemic bowel was resected, and an end-to-end anastomosis was performed using Lambert’s technique. The patient had a smooth recovery. Implementing the effective use of the WHO surgical checklists before incision and before closing the abdomen will prevent foreign body retention, hence reducing post-operative complications. Keywords: Adhesions, Bowel obstruction, Retained foreign body.