A rare sequela of open cholecystectomy: gossypiboma presenting as a subhepatic mass with duodenal sinus - a case report.

Abstract

Introduction: Gossypiboma refers to a retained surgical sponge or gauze left inadvertently after surgery, which is a rare yet serious complication that is often underreported due to medicolegal concerns. Intra-abdominal gossypiboma frequently occurs after cholecystectomy. This case is reportable, as it emphasizes the importance of maintaining a high index of suspicion for gossypiboma in postoperative patients presenting with abdominal pain, as early diagnosis and timely surgical management can help reduce associated morbidity and complications.

Case presentation: A 39-year-old man, who had undergone an open cholecystectomy 4 months earlier, presented with right-upper-quadrant pain for 2 months. Imaging studies demonstrated a gossypiboma in the subhepatic region, with a duodenal sinus draining pus. Exploratory laparotomy revealed two retained surgical sponges, an abscess, and a duodenal perforation. Surgical removal, duodenal repair, and peritoneal lavage were performed, and the patient recovered uneventfully.

Discussion: Retained surgical sponges trigger a foreign-body reaction with two patterns: an acute exudative inflammatory response causing sepsis or abscess, and a chronic aseptic fibrous response with encapsulation and granuloma formation, leading to mass effect, adhesions, bowel erosion, and fistula formation. Because the clinical presentation is often nonspecific and may occur months or years after surgery, diagnosis requires a high index of suspicion. Imaging plays a crucial role, with contrast-enhanced computed tomography being the most useful modality. Definitive management involves surgical removal through endoscopic, laparoscopic, or open approaches, thereby reducing complications.

Conclusion: This case highlights the importance of strict adherence to surgical safety checklist protocols, particularly meticulous sponge counting during surgery.