A gossypiboma, also called textiloma or cottonoid, refers to a foreign object, such as a mass of cotton matrix or a sponge, that is left behind in a body cavity during surgery. It is an uncommon surgical complication. The manifestations and complications of gossypibomas are so variable that diagnosis may be difficult and patient morbidity is significant.

Epidemiology

Although a rare complication nowadays, the true incidence is almost certainly underestimated due to medicolegal implications.

Frequent sites of gossypiboma formation include:

thoracic cavity pleural cavity pericardial cavity

abdominal cavity

Theater 'swab counts' at the end of a procedure before 'closing up' are typically undertaken to prevent retained foreign bodies.

Pathology

Gossypibomas cause two types of responses in the body: exudative and aseptic fibrous. Aseptic gossypibomas can have adhesions, encapsulation, and eventually granuloma formation. Exudative gossypibomas, however, usually occur early in the postoperative period and may involve secondary bacterial contamination, which can result in various fistulas.

Rarely, a foreign body may completely migrate into the small bowel without any apparent opening in the intestinal wall. If it cannot pass the ileocecal valve it can cause complete intestinal obstruction at this level. However, if it passes through this valve, it is then easily discharged through the anus.

An infrequently reported possible complication of a retained surgical sponge is the development of an angiosarcoma 4.

Radiographic features

CT

Gossypibomas are most frequently discovered in the abdomen. Characteristic CT features of abdominal gossypibomas include:

spongiform appearance with gas bubbles

low-density mass with a thin enhancing capsule

calcifications deposited along with the network architecture of a surgical sponge

A sponge left within the pleural space shows no gas lucencies due to resorption of the air by the pleura.

MRI

Signal characteristics vary depending on the content. Commonly reported features include 1:

T1: typically low signal

typically low signal T2: low signal with whorled stripes in the central portion

low signal with whorled stripes in the central portion T1 C+ (Gd): enhancement and in some cases a serrated border to the inner wall

Treatment and prognosis

Re-operation and removal of the gossypiboma.

Differential diagnosis

Foreign bodies like these can often mimic tumors, hematomas, or abscesses clinically and/or radiologically.

History and etymology

The term gossypiboma is derived from the Latin word "gossypium", which means cotton, and the Swahili word "boma", which means place of concealment, thus referring to a retained sponge in the surgical bed.