A retained surgical sponge or towel can be the cause of postoperative bowel obstruction.


Gossypi = cotton


Risk factors for sponge or towel retention:

(1) major open surgery (thoracic, abdominal, cardiovascular, orthopedic, etc)

(2) error in sponge count after surgery

(3) emergency surgery or surgery with major intraoperative problems, especially bleeding

(4) inexperienced surgeon and/or support team

(5) failure to check the operative site prior to closure


Surgical sponges and towels have a radio-opaque marker sewn in which allows visualization on imaging studies. However, these may disintegrate or break down over time, or a sponge without a marker may be used inadvertently.


The presentation may be soon after surgery or delayed for weeks, months or years.


Additional presentations may include:

(1) abscess

(2) fistula

(3) mass mistaken for tumor


The sponge may migrate into a variety of unexpected places:

(1) across the diaphragm

(2) into the urinary bladder

(3) into the intestinal lumen (often associated with an incision in the bowel wall)


To read more or access our algorithms and calculators, please log in or register.