Article

Gossypiboma, Mimic Imaging of Malignant Tumor: Report of Two Cases

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Abstract

Introduction: Gossypiboma is a rare tumor caused by gauze fibers retained during surgery. This medico-legal problem is associated with an increase in patients’ morbidity and mortality. The aim of this study is to report two cases of gossypiboma mimicking the imaging of a malignant tumor. Case Presentation: We report two patients (the first patient was 50 years old, with a history of an appendectomy three years ago in another city; the second patient was 52 years old, with a history of a cesarean section 25 years ago in another hospital) who were admitted to the oncology department of GhaemHospital, Mashhad University of MedicalSciences in 2014. The initial manifestations were signs and symptoms of malignant ovarian tumors, and abdominal ultrasounds and CT scans also indicated malignant tumors.Both patients had a history of a previous laparotomy.Surgical evaluation confirmed gossypiboma as a definite diagnosis. Conclusions: In patients with abdominal or pelvic masses and a history of previous abdominal surgery, the possibility of gossypiboma should be kept in mind.

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We describe a unique case of intra-abdominal textiloma (granuloma due to a retained foreign body), which mimicked a gastric tumor on preoperative imaging studies. A 78-year-old asymptomatic patient with a past history of a gastrectomy was referred for evaluation of an intra-abdominal mass lesion, which was incidentally observed on a computed tomography (CT) scan. Repeated CT with a higher resolution demonstrated a 5-cm heterogeneously enhanced mass with a distinct feeding artery. These findings were all compatible with a tumorous lesion originating in the gastric remnant, most likely gastric gastrointestinal stromal tumor. A diagnosis of textiloma was immediately made during surgery, and it was confirmed pathologically postoperatively. The feeding artery that appeared on CT images, which was a major reason for the false diagnosis, was considered to have resulted from a slow but continuous inflammation reaction around the retained surgical sponge. Surgeons should therefore always take the possibility of textilomas into consideration even with typical tumorous characteristics on preoperative imaging studies, especially in patients with a history of prior abdominal surgery.