Head and Neck Clinic A Gossypiboma From Kazakhstan Tammy M. Holm, MD, PhD 1 , Nikolaos Stathatos, MD 2 , Peter M. Sadow, MD, PhD 3,4 , Amy F. Juliano, MD 5 , Mary Beth Cunnane, MD 5 , Margaret S. Carter, MD 6 , Yash V. Kamani 6 , and Gregory W. Randolph, MD, FACS, FACE 6 Surgical sponges are particularly challenging given their frequent use, small size, and the difficulty in distinguishing a blood-soaked sponge in a hemorrhagic surgical field. Retained surgical foreign bodies are rare, largely preventable potentially dangerous complications. The clinical course of retained sur- gical sponges can be prolonged and asymptomatic or can prog- ress to an acute exudative phase with infection and/or fistula formation. 1 There are various reports of gossypiboma mimick- ing tumor in multiple locations including the chest, abdomen, retroperitoneum, and even the cranium. 2-4 Imaging alone is not reliable for distinguishing between remnant thyroid, recurrent carcinoma, and gossypiboma. 1,5,6 The potential morbidity associated with retained surgical sponges is significant. In our case, resection of the recurrent laryngeal nerve (RLN) resulted directly from the inadvertent retention of a retained surgical sponge and highlights the sig- nificant morbidity associated with this preventable complica- tion. Meticulous sponge count and a thorough surgical site inspection prior to wound closure can help in avoiding gossy- piboma formation and associated morbidity. 7,8 Although gos- sypiboma is rare in routine clinical practice, diagnosis of gossypiboma should be considered in the setting of postsurgi- cal chronic wound infection and/or persistent drainage. Gossypiboma is a term used to describe a mass forming around a surgical sponge that is inadvertently retained at the end of the surgery. We present a case of gossypiboma in the neck. A 54-year-old Kazakhstani man with a recurrent neck mass referred to Massachusetts Eye and Ear for evaluation and surgical management. The patient initially presented to Massa- chusetts General Hospital for endocrine evaluation for further management following total thyroidectomy and neck dissec- tion for papillary thyroid carcinoma performed in Kazakhstan. The history was unremarkable except for postoperative wound drainage lasting for 2 months with a spontaneous resolution. On examination, there was a firm, nonfluctuant, 4.0-cm right- sided neck mass, a thickened cervical scar. The patient had a strong voice and normal vocal cord movements on laryngo- scopy. The cytology showed reactive follicular hyperplasia. The imaging revealed scattered subcentimeter right lateral neck lymph nodes which were considered as suspicious for malig- nancy in the context of the unusual right thyroid bed mass (Figures 1, 2A and B). Considering possible remnant thyroid tissue or recurrent malignancy, multidisciplinary discussion favored surgery. The patient was informed about the potential need for RLN resection due to the proximity of the mass to the expected RLN course, scarring and adhesions from past sur- gery, and prolonged postoperative drainage. Intraoperatively, the mass was densely adherent to the carotid sheath, trachea, larynx, and RLN and was difficult to dissect. Thin, brown fluid Figure 1. Transverse gray-scale ultrasound image of the right thyroid bed demonstrates a 4.8-cm, hyperechoic curvilinear structure (white arrows) with complete posterior acoustic shadowing. 1 Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 2 Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 3 Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 4 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA 5 Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA 6 Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA Received: May 24, 2018; revised: July 1, 2018; accepted: August 7, 2018 Corresponding Author: Gregory W. Randolph, MD, FACS, FACE, Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA. Email: gregory_randolph@meei.harvard.edu Ear, Nose & Throat Journal 1–2 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0145561319840512 journals.sagepub.com/home/ear