Two cases of Gossypiboma -Teaching Points

Case 1

22 year female with puerperal status presents for CT scan abdomen to rule out pelvic infection.  CT  shows enlarged uterus with mixed density lesion in relation to endometrial cavity, anterior wall of uterus with air pockets,  endometrial outline not well differentiated with unremarkable periuterine tissue, cervix, bladder and rectum with no lymphadenopathy or vessels encasement or displacement or hydroureteronephrosis or bowel adherent or ileus or intraperitoneal air – likely represents gossypiboma.

Case 2

23 year female with LSCS 3 months back presents for CT abdomen for pain abdomen. CT shows well defined rounded encapsulated heterogeneous structure with multiple air pockets , hyperdensities  and soft tissue density within it with peripheral enhancement in RIF with broad contact with right wall of uterus & inner margin of anterior abdominal wall & indenting the adjacent bowel loops – likely represents gossypiboma.

Teaching points by Dr MGK Murthy, Dr GA Prasad

            •          Synonym – textiloma or  gossypiboma – mass of cotton matrix left behind in a body cavity after an operation. In Latin gossypium means cotton & Swahili word boma means place of concealment .

            •           Sites – most common in abdominal cavity, other sites – thorax – pleural or pericardial cavity, breast extremities. More common in obese patients. In emergency surgeries.

            •           Cotton or gauze pads can cause foreign body reactions. Some gossypibomas cause infection or abscess formation in the early stage, whereas others remain clinically silent for many years. Surgical sponges are made of cotton that does not stimulate any specific biochemical reaction except adhesion and granuloma formation.

            •           Gossypibomas cause two types of responses in the body: exudative and aseptic fibrous. The latter can have adhesions, encapsulation, and eventually, granuloma formation. Exudative variety usually occurs early in the postoperative period causing secondary bacterial contamination, which results in various fistulas. The longer the retention time, the higher the risk of fistulization.

            •           X rays - most commonly used, if the sponge contains a radiopaque marker, the diagnosis can be made easily on X ray.  Radiographs can also suggest characteristic whorllike pattern or a fine opacity with some mottled small air densities over it.

            •           A hyperreflective lesion with a hypoechoic rim and a strong posterior shadow on ultrasound and a whorllike spongiform hypodense mass with gas bubbles & a thick peripheral rim on CT are the most common findings. Lesion may contain wavy striped high-density areas that represent the sponge itself.