A rare cause of late benign biliary stricture after laparoscopic cholecystectomy: gossypiboma

Gossypiboma refers to a retained cotton-based, non-absorbable foreign body left in the operative field after surgery. Its detection is often difficult and may lead to significant morbidity and mortality. In this case report, we present a case of biliary stricture caused by gossypiboma in a patient who had undergone laparoscopic cholecystectomy 9 months earlier and presented with jaundice. A 64-year-old male had previously undergone laparoscopic cholecystectomy for cholelithiasis. Postoperatively, he experienced recurrent abdominal pain, nausea, and vomiting. In the 9th post-operative month, jaundice and pruritus developed, and laboratory tests revealed cholestasis (total bilirubin: 11.66 mg/dL; gamma-glutamyl transferase: 930 U/L). Magnetic resonance imaging demonstrated intrahepatic bile duct dilatation and a stricture adjacent to a metallic clip. Endoscopic retrograde cholangiopancreatography and percutaneous cholangiography confirmed the obstruction. During laparotomy, a retained surgical sponge (gossypiboma) was identified and removed, and a Roux-en-Y hepaticojejunostomy was performed. The patient recovered uneventfully and was discharged on post-operative day 13. In accordance with surgical safety protocols, performing a final count at the end of the operation, using radio-opaque materials, and maintaining effective team communication are critical measures for preventing such errors. Delayed diagnosis may result in prolonged asymptomatic periods or misdiagnosis due to non-specific clinical findings. In patients with a history of surgery who present with symptoms such as infection, pain, fistula, or a mass, gossypiboma should be considered, and computed tomography should be the preferred imaging modality. Multidisciplinary awareness and meticulous perioperative protocols may significantly reduce this risk. In conclusion, gossypiboma is a complication that is far easier to prevent than to treat.