We describe a case with a perirenal-retained sponge presenting as an adrenal tumor in a patient who had undergone surgery for urolithiasis 10 years prior to presentment. It was incidentally diagnosed during an evaluation of left flank pain.
Rahul Devraj, Vedamurthy Pogula Reddy, Surya Prakash Vaddi, Ajit Vikram, Sreedhar D
Dept of Urology and Renal Transplantation, Narayana Medical College, Nellore, India
Submitted: May 9, 2011
Accepted for Publication: July 25, 2011
KEYWORDS: Retained sponge; Textiloma; Adrenal tumor
CORRESPONDENCE: Vedamurthy Pogula Reddy, MCh, Dept of Urology and Renal Transplantation, Narayana Medical College, Nellore, Andhra Pradesh, India, 524 002 ().
CITATION: UroToday Int J. 2012 Feb;5(1):art 85. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.03
Despite the widespread use of radio-opaque-labeled surgical sponges, retained sponges, or so-called textilomas from previous surgical procedures, are still causing diagnostic and therapeutic problems. We present an unusual case and late discovery of a retained sponge, 10 years after pyelolithotomy, mimicking an adrenal tumor.
A 52-year-old man was admitted to the hospital with the complaint of left flank pain. He was a known hypertensive. He underwent left pyelolithotomy 10 years before admittance. On physical examination, a left flank incision scar and left flank tenderness were noted. His serum creatinine was 1.8 mg. An ultrasound of the abdomen and a plain CT scan of the abdomen showed a left adrenal tumor (Figure 1). Biochemical evaluation revealed normal urinary catecholamine metabolites and serum cortisol levels. A left retroperitoneal adrenalectomy was planned. During the operation, the left adrenal gland was normal and a 6 cm by 5 cm mass was seen lateral to the left suprarenal gland. Dense adhesions were present between the mass, the left adrenal gland, and left kidney. The mass was excised in toto. A cut section revealed a surgical sponge encapsulated by a thick, fibrous wall (Figure 2).
The abdomen, pelvis, and retroperitoneum are the most common locations associated with retained surgical foreign bodies (RSFB) . RSFB in these anatomic areas can vary from an asymptomatic, retained foreign body detected accidentally on diagnostic imaging to sepsis, bowel obstruction, and fistula formation. Asymptomatic soft-tissue mass suspicious for an abscess or a soft-tissue tumor has also been described as presenting features of RSFB in the abdomen, pelvis, and retroperitoneum [2,3].
Damage control operations for trauma or non-traumatic etiologies can be associated with significant potential complications. These procedures often utilize a large number of surgical sponges to attain hemostasis. If these sponges are left in place or not exchanged for new sponges within 4 days of their initial placement, the risk of abdominal infection and/or abscess increases. Therefore, patients who have undergone abbreviated (damage control) laparotomy for trauma or non-trauma indications may benefit from routinely scheduled roentgenograms to help document and/or identify abdominal RSFB. More recently, the introduction of radio-frequency devices that are able to detect appropriately radiolabeled surgical sponges has provided surgical teams with another method of preventing RSFB . Simultaneous use of radio-frequency labeled sponges, surgical counts, and/or radiographs will likely increase early detection of RSFB .
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