Gossypiboma Mimicking Ovarian Mass: A Rare Case Report from Rwanda

Gossypiboma, also referred to as textiloma, denotes a retained surgical item most often cotton gauze left inadvertently within the body following a surgical procedure. The condition can provoke granulomatous and suppurative reactions leading to abscess formation, fistulae, adhesions, or mass effect. Its estimated incidence ranges from 1 in 1000 to 1 in 1500 intra-abdominal operations.

A 32-year-old woman presented with a progressively enlarging lower abdominal mass associated with mild pain. She had a history of cesarean section 16 years earlier. Clinical examination revealed a uterus consistent with 20-week gestation size and a right-sided, mobile, non-tender mass. Due to resource limitations, advanced investigations such as MRI and tumor markers were not performed. Pelvic ultrasound suggested an ovarian mass. At laparotomy, a 10×8 cm mass was identified, densely adherent to the adnexa, bowel, and omentum. Dissection proved technically challenging, necessitating intraoperative consultation with a general surgeon. During the procedure, the mass ruptured, releasing an abdominal pack. A right salpingectomy and removal of the foreign body were performed. Despite extensive adhesions, the mass was successfully excised. The patient had an uneventful recovery and was discharged on postoperative day four.

Gossypiboma, though uncommon, is a serious complication typically seen after abdominal and gynecologic surgeries. Therefore, implementing reliable tracking systems, reinforcing nursing count, and consistently applying surgical safety checklists are essential steps in minimizing the risk of such avoidable occurrences.