Abdominal pain secondary to gossypiboma that developed over 22 years: Case report

Surgical instrument retention continues to occur despite considerable preventive efforts. The resulting infection can be asymptomatic or demonstrate variable clinical presentations, such as intestinal obstruction, malnutrition, gastrointestinal bleeding, peritonitis, adhesions, fistulas, abscesses, erosion and/or intestinal perforation. In this case report, we present a patient whose last surgical event occurred 22 years prior with appendicular symptoms and a palpable abdominal mass.

The patient was a 42-year-old female with a history of three caesarean sections, the last one occurring 22 years prior. Her condition began with abdominal pain predominantly in the right iliac fossa, with a pain severity scale of 8/10, a palpable mass in the upper quadrants and mesogastrium of approximately 20 cmx10 cm. Clinical studies suggested a tumour in the epigastrium and mesogastrium; a subsequent exploratory laparotomy revealed a tumour with firm adhesions in the caecal appendix and omentum, a textiloma and a caecal appendix. The patient's condition evolved satisfactorily.

The textiles that are normally used for surgery are fibrous, with absorbent materials composed of sterilized cotton or synthetic fabrics. The most common sites of gossypiboma are the abdomen (56 %), pelvis (18 %) and thorax (11 %). The common clinical symptoms (50 %) are vague, occur in the gastrointestinal region, and include mild abdominal pain, nausea, and vomiting. The formation of adhesions, abscesses and fistulas has been reported in up to 31, 24 and 20 % of patients, respectively.

Gossypiboma is an unwanted but preventable surgical complication that is associated with increased morbidity and mortality from abdominal surgeries.