Residual hemostatic material (Surgicel) mimicking endometriosis: a case report of gossypiboma

Gossypiboma, the unintentional retention of surgical materials, is a rare but significant postoperative complication. While most of the literature focuses on retained sponges, absorbable hemostatic agents such as Surgicel may also fail to degrade, particularly in highly inflammatory surgical environments. This retained material triggers a foreign-body granulomatous reaction, leading to pelvic mass formation and chronic inflammation. Because clinical symptoms can manifest weeks or even years later, these retained agents frequently mimic pathologic lesions on imaging, presenting a major diagnostic dilemma that delays definitive care.

We report the case of a 24-year-old woman who presented with recurrent pelvic pain and a mild fever 2 months after a right ovarian cystectomy. Repeated imaging studies revealed a cystic mass in the pelvic area that was mistakenly interpreted as an endometrioma or an inclusion cyst. Finally, during diagnostic laparoscopy, fragments of Surgicel material were discovered and removed from the previous surgical site. The patient made a complete recovery after surgery.

Retained Surgicel can mimic endometriotic pelvic lesions on imaging, leading to delayed diagnosis unless the surgical history and serial imaging findings are carefully considered.

This case emphasizes that retained absorbable hemostatic agents such as Surgicel may closely mimic endometriotic or inclusion cysts on serial imaging, leading to diagnostic delay.