Unintentionally retained surgical gauze presenting as chronic infected fistula to the surgical wound: a report of two cases

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. 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. 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.