Case Archive
General Surgery, Pathology, Oncology
Ref. # 49987

A 34 year old Michigan man underwent a splenectomy and staging laparotomy for radiated Hodgkin's Disease. A CT scan had been positive for splenic involvement; a gallium scan had been negative. Six months later he returned to the hospital with extreme pain in his abdomen. X-rays revealed the presence of a surgical sponge and jejunal perforation. The same surgeon performed an operation to remove the sponge and documented finding it in the jejunum. Two days later, while ambulating with assistance of the hospital staff, the patient expired as a result of a massive pulmonary embolism. A medQuest general surgeon reported it was negligent to leave the sponge in during the first operation. Furthermore, it was impossible for the sponge to be inside the jejunum unless the patient had swallowed it. After reviewing the slides, a medQuest pathologist reported a pocket had formed outside the duodenum for some time and burrowed into the duodenum. There was no trace of the sponge itself and nothing inside the duodenum. The surgeon probably had instructed his pathologist to take multiple slides. A medQuest oncologist reported there is a 51%-60% cure rate for this type of Hodgkin's Disease. Had the sponge not been left in, the patient more likely than not would have survived.

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