Surgeon Fails to Remove Surgical Sponge Before Closing Trauma Patient

This case involves a male patient who sustained a number of traumatic wounds during a serious skiing accident. He underwent surgery in order to repair internal bleeding, and was closed after several hours. However, a felt sponge was inadvertently left in his chest cavity. Subsequently, the patient began experiencing several symptoms including severe fatigue, constant pain, nausea, and vomiting. Several weeks later, a workup revealed the likelihood of a foreign body in his chest cavity. The sponge was successfully removed but the patient suffered from several complications including bleeding and abscess.

Question(s) For Expert Witness

1. How frequently do you treat patients who require similar surgery?

2. What safeguards exist to ensure that surgical sponges have been removed?

3. What kind of complications can result from leaving a sponge in the chest cavity?

Expert Witness Response E-088005

I work in a level 1 trauma center in Chicago and chest injuries are relatively common with 1-2 per month in my practice. Numerous safeguards should be in place to prevent these type of events. All sponges should be counted at the beginning and end of the case. Discrepancies should trigger a reexploration of the surgical field and mandate an Xray in the operating room. In emergencies, when a count cannot be performed at the beginning of the case, surgical exploration prior to closure and in room Xray should be routine. Several additional systems using RF-ID technology or magnetized scanners are also available and in variable use by hospitals, making these 'never-events'. If not identified in the operating room, but found later, reexploration for early removal should be pursued unless contraindicated. Complications can range from pain, infection, erosion into other internal structures, obstruction of blood vessels/bowel/airways, chronic inflammation, and non-healing wounds/fistula formation among other things depending upon the location of the foreign body. Often this necessitates further surgery which is typically quite complex.