A 38-year retained gossypiboma fortuitously diagnosed after suspected ovarian tumor surgery: a case report

Gossypiboma is a diagnostic challenge, particularly in long-standing cases where characteristic imaging features may be lost. We report the case of a 78-year-old woman with a sponge retained from an abdominal hysterectomy performed 38 years earlier. The pelvic mass was incidentally detected on computed tomography (CT) and misdiagnosed as a solid ovarian tumor on magnetic resonance imaging, prompting a laparotomy. Intraoperatively, the mass was revealed to be a retained sponge; however, complete resection was impossible due to severe adhesions and massive bleeding. During follow-up without reoperation, the patient developed abdominal pain 16 months later, and CT showed a small bowel fistula and an intra-abdominal abscess. Due to the high surgical risk and the fact that resection of the mass would be extremely difficult, a diverting loop ileostomy was created to control the inflammation. This case highlights the difficulty of preoperative diagnosis and discusses optimal management strategies for long-standing, asymptomatic gossypiboma.