Gossypiboma following cesarean section presenting as acute abdomen and sepsis: a case report

Gossypiboma is a problematic but rare and highly preventable surgical complication. The incidences of gossypiboma are vastly underreported; therefore, the actual incidence is unknown. Women undergoing obstetrical procedures constitute a fairly high proportion of patients with gossypibomas. Most cases present after months or years, and only a few cases have been reported that presented acutely within days.

We present a case of a woman who presented with severe symptoms of intestinal obstruction leading to acute abdomen merely a week after her caesarean section. The ultrasound and CT scans could not diagnose the foreign body; hence, a provisional diagnosis of gallstone ileus was made based on ultrasound findings and the patient's symptoms. However, an exploratory laparotomy was performed when the patient's condition deteriorated, which then revealed a retained gauze from the patient's abdomen.

Gossypibomas, although rare, can lead to serious complications such as fistulas, abscesses, and intestinal obstruction. They are often asymptomatic and discovered incidentally but can present with severe symptoms if they cause abscess formation or obstruction. Surgical sponges and gauze typically contain radiopaque markers to aid detection via ultrasound and CT scans. However, the continued use of non-radiopaque materials, especially in developing nations, contributes to delayed diagnosis and treatment. Surgical removal of the retained foreign body remains the only definitive treatment.

Gossypibomas are highly preventable if care is taken by healthcare professionals. Keeping count of the packs and tagging the packs with markers is an effective method of preventing this negligence.