Unintentionally retained surgical gauze presenting as chronic infected fistula to the surgical wound: a report of two cases
Bibliographic record
Abstract
INTRODUCTION: Retained foreign objects represent a critical yet preventable failure in surgical safety systems worldwide, reflecting systemic weaknesses that threaten patient outcomes. Persistent postoperative fistulae are a potential clinical marker of such retained foreign objects, but they are often underrecognized, particularly in resource-limited settings. By reporting these cases, we aim to underscore the diagnostic value of wound fistulae as a sentinel sign of retained foreign objects and to highlight the ongoing gaps in surgical safety systems. CASE PRESENTATION: Two African females presented with chronic, non-healing wounds accompanied by persistent fistulous discharge following previous surgical procedures. The first patient, 46-year-old, experienced abdominal pain and ongoing wound discharge that persisted for five months after undergoing a hysterectomy. Diagnostic imaging identified a retained abdominal pack which had migrated into the bowel, resulting in both an enterocutaneous fistula and an interloop fistula. Accordingly, a revision laparotomy was performed four days post-presentation, entailing the removal of the retained abdominal pack along with segmental resection of the ileum followed by primary anastomosis. The second patient, 45-year-old, presented with persistent drainage from a neck wound six months after thyroidectomy, notwithstanding several unsuccessful wound explorations. Operative exploration carried out two days after presentation revealed retained gauze within a fistulous tract. In both instances, surgical extraction of the retained foreign objects led to complete resolution of symptoms. CONCLUSION: These cases expose the systemic deficiencies in operative safety that permit the occurrence of retained foreign objects, leading to severe patient harm and prolonged morbidity. They highlight the urgent need to reinforce surgical safety culture, ensure strict compliance with established checklists, and implement reliable detection protocols. Addressing these systemic gaps is essential to prevent such avoidable complications and improve patient safety outcomes globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".