Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.
Retained foreign body (RFB) has been reported after abdominal, thoracic, cardiovascular, orthopedic, and neurosurgical procedures [
A 38-year-old woman with 27.3 BMI needed an emergency caesarean section in the fourth delivery 14 months ago in public hospital. After caesarean section, the surgeons had to perform hysterectomy due to continued bleeding. Medical record revealed no postoperative complication and the patient was discharged after one week from the hospital. In the follow up, the patient suffered sometimes from mild intermittent abdominal pain only. However, the surgeons did not perform advanced examinations and the problem was explained with postoperative adhesions. The patient was satisfied with surgeons’ statements and did not continue the followup. But, after 13 months of operation, mild intermittent abdominal pain was converted to mild abdominal colic and the patient felt discomfort. Hence, last week before admittance to hospital, intermittent fever, which reached up to 39°C, and severe abdominal colic emerged. The patient was admitted to emergency department with above mentioned symptoms. Physical and laboratory examinations showed that the blood pressure was 100/80 mmHg, pulse was 110/min, body temperature was 38.5°C, WBC was 6.3 × 103/µL, and CRP was 241 mg/L. Abdominal USG shows a mass in pelvic area, but the source is not certain. CT demonstrated that a mass (15 × 13 cm) with a dense central part and an enhancing wall (gossypiboma) was located in the pelvic area (Figure
Abdominal CT scan revealed intra-abdominal mass—gossypiboma.
Exploratory laparotomy revealed an encapsulated sponge surrounded by omentum.
Perforation area on small bowel.
Surgical specimen (gossypiboma).
The reported incidence of retained surgical sponge is one per 1,000–15,000 abdominal operations [
The retained surgical sponge triggers two biological responses named as aseptic fibrinous responses due to foreign body granuloma or exudative reaction leading to abscess formation [
Migration of retained sponge into bowel is rare but does occur when compared to abscess formation and occur as a result of inflammation of the intestinal wall that evolves to necrosis [
Operation under emergency conditions, involvement of more than the surgical team in the operation, change in assistant staff during operation, increased BMI, volume loss, number of surgeons, and female gender are all risk factors for RFB [
As a result, Gossypiboma is usually asymptomatic, has nonspecific radiological findings, and is a rare condition. These situations might delay the diagnosis. Also, a gossypiboma can cause complications such as perforation and adhesion to the adjacent structures. In order to avoid gossypiboma, the surgeons should comply with recommended statement on the prevention of retained foreign bodies after surgery. Atypical abdominal pain should be kept in mind since the gossypiboma even out of operation for a long time can be passed.
The authors declare that there is no conflict of interests regarding the publication of this paper.