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GAUZE SPONGE PSEUDOTUMOR IN A DOG

Gauze sponge granuloma (pseudotumor) is a situation where irritation and trauma to local tissues around a retained gauze sponge stimulates an aggressive scar tissue formation. Sterile and non sterile abscessation of the fibrous scar tissue may be present and adversely impact the patient.  Over an extended period of time, the pseudotumor (a mass of tissue that mimics a tumor) can damage nearby structures, occlude the lumen of intestines or fluid tracts such as the urethra or ureters, stimulate episodic fevers, be a focus of infection and cause discomfort.  Upon radiography or ultrasonography these intra-abdominal gauze sponge granulomas appear as a tumor formation. 

Leaving a gauze surgical sponge in a patient is something every surgeon fears...  and takes conscientious precautions to safeguard against.  From the very first day of veterinary surgical training, emphasis is given to the need to prevent leaving any foreign material in the surgical site.  Surgery is a human endeavor.  With that in mind, inherent in any surgical procedure is the possibility that something may be overlooked, ignored, misinterpreted, mishandled, lost, stressed, or damaged.  No surgeon takes lightly the responsibility of performing an operation on a living patient. On occasion an unforeseen and unpleasant adverse event may occur.  In the case presented here, the patient recovered quickly from the surgical procedure that involved removing the pseudotumor as well as a kidney that was damaged by an occluded ureter.

GAUZE SPONGE GRANULOMA... also called a PSEUDOTUMOR
If a gauze surgical sponge inadvertently remains within the tissues of a animal (or human) at the time of surgery, this sponge reacts with the living tissues and through the tissue irritation the animal's defensive immune mechanisms try to rid the body of the foreign object.  As a result, fibrous connective tissue is deposited around the foreign body stressor and the object is walled off from the local tissues.  Due to the particularly reactive nature of the gauze sponge material (cotton) the resulting granuloma that forms may be rather sizeable.  In the case presented here the pseudotumor was three inched in diameter with the gauze sponge compressed within the center of the granuloma.  The sponge was hidden near the entry of the right ureter into the right side of the bladder.  The granuloma was so intense that the scar tissue from the reaction obstructed the flow of urine from the right kidney into the bladder.  The final outcome for the right kidney and ureter was a buildup of pressure and infection... and eventually a totally nonfunctional and cavernous kidney.  When incised post operatively, the kidney was filled with an infected fluid and all that remained of the kidney was a fibrous capsule an no visible normal kidney parenchyma.

Removing A Gauze Sponge Pseudotumor From A Dog
Gauze Sponge  Granuloma	Click on an image  for full size view in a new window	Foreign Body  Granuloma
A firm, three inch diameter mass was palpable in the dorsal lower abdomen.  The forceps points to the area of the lower abdomen under which lies the mass.	A nondescript mass adhering to the right wall of the bladder and incorporating the omentum, suspensory ligament of the bladder and encircling the right distal ureter was discovered.	Surgical removal of the mass required separating it from the bladder wall and subsequent repair of the bladder wall.  As well, the ureter was removed from its entry into the bladder and the distended, turgid right kidney was removed.
This view of the incised kidney shows the extensive destruction of the internal kidney tissue.	The incised pseudotumor shows the gauze sponge deep within the granuloma.	The extensive scar tissue attempting to wall off the gauze foreign material is infiltrated with small abscesses and necrotic foci.

This patient is a 135 pound Saint Bernard and it recovered normally from surgery.  The urinary tract will be evaluated routinely for the rest of it's life and a high quality, meat-based diet will be fed.  The probability of a normal and long life is good.

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