Textiloma mimicking an intra-abdominal tumor: A case report from a medicolegal point of view

Textiloma is a pseudotumor arising from a nonabsorbable retained cotton matrix, incidentally left behind during surgery, which has triggered an inflammatory reaction. This study describes a case of intra-abdominal textiloma, which mimicked a small bowel tumor on preoperative assessment. A 24-year-old asymptomatic female patient, who had undergone open appendectomy at the age of 20, presented to our institution with incidental finding of a large solid mass in the small bowel, covered by the omentum. Abdominal computed tomography showed an enhanced tumoral mass occupying the right intraperitoneum. During the laparoscopic exploration, the tumor was identified attached to the small bowel loop; small bowel en bloc resection was performed. Pathology results were compatible with a piece of gauze surrounded by reactive changes adherent to the small bowel (textiloma). The patient had a good recovery, and postoperative follow-ups were uneventful. The case offers a medicolegal perspective of this not uncommon, yet avoidable, problem and assesses the difficulties of assigning the responsibility for its occurrence to surgical team members and operating room staff.