Laparoscopic approach to pelvic gossypibomas with abscess formation: a case series

Gossypibomas are rare but serious postoperative complications resulting from retained surgical gauzes. They can cause chronic inflammation, abscess formation, and adherence to adjacent pelvic structures, leading to diagnostic and therapeutic challenges. Laparoscopic management of these cases remains underreported. This case series presents three rare pelvic gossypibomas successfully managed via minimally invasive surgery.

Case 1: A 61-year-old woman, 2 years post-total abdominal hysterectomy, presented with chronic pelvic pain and urinary tract infection. Imaging revealed a pelvic abscess containing a retained gauze. Laparoscopy identified dense adhesions and an iatrogenic bladder injury, which was immediately repaired. The gauze was removed, and recovery was uneventful.Case 2: A 42-year-old woman, 18 months after cesarean section, presented with abdominal pain and altered menstrual cycles. Imaging showed a gauzoma-related abscess adherent to the anterior abdominal wall and right adnexa. Laparoscopic excision of the gauze and concurrent appendectomy were performed, preserving the ovary and fallopian tube. Recovery was uneventful.Case 3: A 36-year-old male, 24 years post-right orchiectomy, presented with right iliac fossa pain, low-grade fever, and worsening renal function due to ureteral compression by a small pelvic gauzoma. Following double-J ureteral stenting, laparoscopy successfully removed the gauze without injury to surrounding structures, and renal function improved postoperatively.

Pelvic gossypibomas may remain undiagnosed for years, presenting with non-specific gastrointestinal, genitourinary, or systemic symptoms. Imaging, including ultrasound and CT, is essential for diagnosis. Laparoscopy offers a safe, effective approach for adhesiolysis, foreign body removal, and management of associated complications, including abscesses and organ compression.

Laparoscopic management of postoperative pelvic gossypibomas is feasible, safe, and effective, even in complex cases with adhesions, abscess formation, and proximity to vital structures. This minimally invasive approach provides excellent outcomes, rapid recovery, and high patient satisfaction, highlighting its role as a preferred alternative to open surgery in selected patients.