For years after undergoing abdominal surgery, Usha Joseph had been experiencing persistent abdominal pain that remained unexplained despite multiple consultations. Recently, when she developed hematuria (blood in urine), she sought care from a urologist, who advised an X-ray as part of the evaluation for urinary tract pathology. The imaging unexpectedly revealed a metallic surgical instrument, later identified as an artery forceps lodged inside her abdomen. Following the discovery, Usha filed a formal complaint with health authorities, prompting an official investigation into possible medical negligence.
Fifty-one-year-old Usha Joseph, a native of Punnapra in Kerala, underwent surgery at the Government Medical College Hospital, Vandanam, Alappuzha in May 2021. The procedure was a hysterectomy (removal of the uterus) to excise a large uterine fibroid of 3.5 kg.
After the 2021 surgery, Usha experienced recurring abdominal pain and episodes of pain with urination (hematuria). Despite multiple consultations at the original medical college, the cause of her symptoms remained undiagnosed for years.
Recent discovery explained her long-standing symptoms and urinary infection concerns.
Following the X-ray discovery and family complaints, the Directorate of Medical Education, Kerala, and the hospital launched inquiries. Based on the preliminary investigation:
Dr. J. Shahida, the surgeon who conducted the 2021 surgery, was suspended from her post pending further inquiry.
P. S. Dhanya, the scrub nurse present during the procedure, was also placed under suspension.
These actions are administrative measures while the detailed probe continues.
A four-member expert committee has been formed to examine medical records, determine when the instrument was left behind and identify lapses.
Hospital records and a probe panel later indicated that Usha had previously undergone another abdominal surgery in 2007 at the same institution to remove an ovarian cyst. This raised questions about when exactly the surgical instrument was left inside her body.
A previous similar case has been reported by MedBound Times from Kozhikode Medical college, Kerala in 2024 involving retaining an artery forceps in the abdomen of a woman after C-section.
The object identified on imaging was described as a small pair of artery forceps, a common surgical clamp used to control bleeding or grasp tissues during procedures. While some involved personnel later referred to it as a “mosquito forceps” (a smaller variant), any retained surgical instrument is considered a retained surgical item (RSI) and a serious patient safety incident.
In medicine, strict protocols such as the World Health Organization (WHO) Surgical Safety Checklist mandate counting all instruments and sponges before and after surgery to prevent such occurrences.
Dr Lalithambika Karunakaran, former Head of Obstetrics and Gynaecology at Alappuzha Medical College, who was named in initial media reports due to her role as unit chief, stated that, she did not personally perform the surgery and was engaged with COVID-19 duties at the time even the family members of the patient reported of consulting her privately in her home. She also said that "the instrument seen on X-ray may have been from a previous surgery and it could be a magnified view".
She described the instrument as small and suggested that the presence of such a foreign object might not necessarily cause problems even over decades, a statement that drew public attention and criticism.
The Health Minister of Kerala, Veena George, reaffirmed that strict action would be taken based on investigation findings and that staff involved who are still in government service have been suspended.
Retained surgical items are considered serious medical errors and are often classified as “never events”, adverse events that should never occur if safety protocols are followed correctly. Detection can occur months or years after the original surgery, typically through imaging studies like X-rays or CT scans when unexplained symptoms persist.
Patients with RSIs may experience pain, infection, organ damage or urinary symptoms depending on the instrument’s location and involvement with internal tissues. Surgical removal is generally recommended to prevent further complications.
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