Gossypiboma: An unusual presentation as lower urinary tract symptoms

Gossypiboma is retained surgical swab following any surgical procedure. Its diagnosis is usually difficult because of variable and nonspecific clinical symptoms. It is a serious but preventable surgical event. It continues to occur despite considerable patient safety efforts.

A forty-eight-year-old female patient presented with worsening abdominal pain, decreased appetite, and constipation associated with severe lower urinary tract symptoms. She had undergone appendectomy 10 months back and postoperatively she was having recurrent episodes of abdominal pain. Two months before her current presentation she presented with dysuria, urgency, and urge incontinence and she was diagnosed to have a bladder mass by ultrasonography and cystoscopy. Transurethral resection of bladder tumor was done but there was no symptomatic improvement. On physical examination, there was a right lower quadrant transverse surgical scar and suprapubic and right lower quadrant tenderness. Abdominal computed tomography (CT) scan showed focal bladder wall thickening and suprapubic intra-abdominal bubbly mass with minimal right lower quadrant collection. Exploratory laparotomy revealed a foreign body covered by adherent small bowel loops. Two perforations in the ileum were identified. Foreign body removal and segmental ileal resection and anastomosis were done. After the surgery, all symptoms disappeared.

Retained abdominal swabs remain a difficult challenge in current problem surgical practice. Clinical manifestation shows vast variation which relates to the location of the material within the abdomen. The clinical presentation is dictated by the type of foreign-body reaction.

Prevention is better than cure. Since the first report of a retained swab was by Wilson in 1884, there has been constant development of techniques and protocols to decrease its incidence. It is crucial to take all necessary measures to prevent its occurrence. Gossypiboma should be on the list of differential diagnoses if the patient has previous surgery.