Gossypiboma Following Emergency Caesarean Section Leading to Left Adnexectomy: A Case Report

Abstract

Introduction: Gossypiboma refers to a mass of cotton that is accidentally forgotten in the body cavity after a surgical procedure. It is otherwise called textiloma. Gossypiboma accounts for 80% of retained foreign bodies after a surgical procedure. Aim: Although most gossypiboma occur following gynaecological surgery, there are reports of its occurrence following emergency caesarean section. This case is being reported to further emphasise the need for a high index of suspicion for gossypiboma in any patient with recurrent abdominal pain with a previous history of surgery. This case report also revealed that gossypiboma can have a significant consequence on the reproductive carrier of the affected patient. Preventing gossypiboma should be seen as a collective responsibility of the entire surgical team. Case Presentation: A 20-year-old P1+0 (Not alive) woman who presented with a history of abdominal pain associated with abdominal swelling and fever 8 months after an emergency caesarean section. The caesarean section was on account of placental abruption and intrauterine fetal death at a private hospital.  At presentation, we found a young woman, conscious, not pale, afebrile. Vital signs were essentially normal. Abdominal examination revealed a mass at the left iliac fossa region with tenderness. Abdominopelvic ultrasound showed a thick-walled heterogeneous lesion in the left adnexal measuring 81 by 66mm in size with an echogenic part casting a posterior acoustic shadow. A computerized tomography scan was considered as it is the gold standard investigation for gossypiboma, but this is not readily available in our facility. She subsequently had an exploratory laparotomy with left adnexectomy. Intraoperative findings revealed a 6 by 8cm left adnexal mass (Incorporating the left fallopian tubes and the left ovary) that was walled off by omentum with purulent exudate. Her postoperative period was uneventful. Discussion: Gossypiboma is a mass of cotton forgotten after a surgical procedure. Patients undergoing a multicavity procedure are at greater risk of having a gossypiboma. Its clinical presentation varies with symptoms and the timing of occurrence. Management depends mainly on the presentation of the patient. Gossypiboma is associated with significant medicolegal concerns. Conclusion: Gossypiboma is associated with significant physical, psychological, economic, and medicolegal complications; thus, comprehensive preventive measures must be implemented to mitigate its occurrence. Preventing its occurrence should be seen as a collective responsibility of the entire surgical team.