gossypiboma , term is derived from the combination of latin words  gossypium  ( cotton ) and the swahilli  boma  ( place of concealment ) . gossypiboma is a term used to describe a mass within the body that comprises a cotton matrix surrounded by a foreign body reaction . another term ,  textiloma  which originated from the  textilis  - weave in latin and  oma  - disease , tumor , swelling in greek . it refers both to a fabric body involuntarily left in the patient during surgery and the reactions secondary to its presence in the body . surgical mop retained in the abdominal cavity following surgery is a serious , but avoidable complication . two usual responses to retained mops are exudative inflammatory reaction with formation of abscess , or aseptic fibrotic reaction to develop a mass that leads to future complications . a 45-year - old female patient referred to our center with complains of acute pain and distention of the abdomen . she was a known case of diabetes and hypertension for the last 3 years with well controlled status . it was learned from her past history that she underwent abdominal hysterectomy and bilateral salpingo - oopherectomy for menorrahagia due to fibroid uterus . a vertical midline scar was present ; a large cystic mass was felt ~20x20 cm size with restricted mobility and smooth surface . abdominal ultrasonography showed a round mass of 16 - 18 cm size with fluid echogenicity in the right lower quadrant . in the abdominal - pelvic computerized tomography ( ct ) scan , a heterogeneous cystic soft tissue mass of 24 cm size was found in the right lower quadrant of abdomen [ figure 1 ] . she was planned for exploratory laparotomy under general anesthesia with suspected diagnosis of twisted ovarian cyst from incidentally left ovarian tissue . the mass was intraperitoneal , lying between loops of the small intestine [ figures 2 and 3 ] . but , because of multiple adhesions , it ruptured with expulsion of yellow , thick pus in which a sponge was found [ figure 4 ] . pus samples were sent in a sterile container for culture and sensitivity . the sponge was removed and peritoneal lavage was done . ct scan of abdominopelvic region showing an extent of mass ( cystic lesion with hyperechoic shadow inside ) after evacuation of pus showing cyst wall ( holding with artery forceps ) after opening cyst wall retained foreign body in situ specimen of a sponge as retained foreign body removed from abdomen an acute surgical abdomen is one of those cases in which a patient needs emergent evaluation , treatment and likely requires emergent operative treatment . the causes can be mesenteric ischemia , appendicitis , cholecystitis , diverticulitis , bowel obstruction etc . an adult patient with an acute abdomen generally appears ill and has abnormal findings on physical examination there can be upper and lower gastrointestinal ( gi ) signs and symptoms with signs of peritonitis . gossypiboma cases generally have subacute or chronic presentation that is different from rest of the cases of acute abdomen . this case is an important pearl to revisit the gossypiboma / retained postoperative foreign body ( rfp ) . the gossypiboma cases can leads to embarrassment , humiliation , job loss , and law suit worldwide . data concerning the actual incidence is difficult to estimate because of a low reporting rate due to medicolegal implication . it varies between 1 out of 1,0001,500 intra - abdominal operations and 1 out of 3001,000 of all operations . it is difficult to recognize a gossypiboma by using radiological screening if the sponge does not have any radiological marker on itself , because the cotton can simulate hematoma , granulomatous process , abscess formation , cystic masses or neoplasm . the possibility of a retained foreign body should be in the differential diagnosis of any postoperative patient who presents with pain , infection , or palpable mass . the low index of suspicion is due to rarity of the condition and latency in the manifestation . if the diagnosis is made early , laparoscopic retrieval may be feasible . according to recent review article by wan et al . , about retained sponges , gossypibomas were most commonly found in the abdomen ( 56% ) , pelvis ( 18% ) , and thorax ( 11% ) . the most common detection methods were computed tomography ( 61% ) , radiography ( 35% ) , and ultrasound ( 34% ) . pain / irritation ( 42% ) , palpable mass ( 27% ) , and fever ( 12% ) were the leading signs and symptoms , but 6% of cases were asymptomatic . complications included adhesion ( 31% ) , abscess ( 24% ) , and fistula ( 20% ) . average discovery time equalled 6.9 years with a median ( quartiles ) of 2.2 years ( 0.3 - 8.4 years ) . in the case report which was conducted by sumer et al . the possible causes of sponge retention are emergency surgery , unexpected change in the surgical procedure , disorganization ( e.g. poor communication ) , hurried sponge counts , long operations , unstable patient condition , inexperienced staff , inadequate staff numbers , and obesity . most cases occurred when the sponge count was falsely pronounced correct at the end of surgery . gossypiboma most commonly occurs after gynecological and upper abdominal emergency surgical procedures , but it may also follow thoracic , orthopedic , urological , and neurosurgical procedures . because the symptoms of gossypiboma are usually nonspecific and may appear years after surgery , the diagnosis of gossypiboma usually comes from imaging studies and a high index of suspicion . the clinical presentation of gossypiboma is variable and depends on the location of the sponge and the type of reaction . there are two types of foreign body reactions in pathology : an exudates reaction leading to abscess formation like our case and chronic internal or external fistula formation . another is an aseptic fibrinous reaction resulting in adhesion , encapsulation , and eventual formation of granuloma . the latter usually presents much later than exudates reaction sequelae . they usually remain asymptomatic or present with pseudotumor syndrome . common symptoms and signs of gossypiboma are abdominal distension , ileus , tenesmus , pain , palpable mass , diarrhea , abscess , and fistula formation , nausea , vomiting , anorexia , and weight loss resulting from obstruction or a malabsorption type syndrome caused by the multiple intestinal fistulas or intraluminal bacterial overgrowth . retained surgical sponges can cause serious consequences , such as bowel or visceral perforation , obstruction or fistula formation , sepsis or even death . intraabdominal gossypibomas can migrate into the ileum , stomach , colon or bladder without any apparent opening in the wall of these luminal organs . the inflammatory granulomatous reaction is the most likely cause of the extraosseous accumulation of technetium-99m - methylene diphosphonate ( tc-99 m mdp ) in gossypibomas as studied by nuclear medicine study . recently , new england journal of medicine published an article about risk factors of retained foreign bodies ( rfbs ) . of the 8 risk factors , the authors identified only 3 ( emergency surgery , unplanned change in the operation , and body mass index [ bmi ] ) were found to be statistically significant by multivariate logistic regression . the most impressive imaging finding of gossypiboma is the curved or banded radio - opaque lines on plain radiograph . the ultrasound feature is usually a well - defined mass containing wavy internal echogenic focus with a hypoechoic rim and a strong posterior shadow . on ct , a gossypiboma may manifest as a cystic lesion with internal spongiform appearance with mottled shadows as bubbles , hyperdense capsule , concentric layering , and mottled shadows as bubbles or mottled mural calcifications . magnetic resonance imaging ( mri ) features of gossypiboma in the abdomen and pelvis , which include the delineation of a well - defined mass with a peripheral wall of low signal intensity on t1- and t2-weighted imaging , with whorled stripes seen in the central portion and peripheral wall enhancement after intravenous gadolinium administration on t1-weighted imaging . prevention of gossypiboma can be done by simple precaution like keeping a thorough pack count and tagging the packs with markers . newer technologies are being developed that will hopefully decrease the incidence of rfp , like radiofrequency chip identification ( rfid ) by barcode scanner . the overall objective of this system would be to eliminate errors in the sponge count by removing the human error factor . furthermore , the sponge count protocol itself has been implicated as a hazard to patient safety . present case is an important pearl that one must be aware of the risk factors that could lead to a gossypiboma and take measures to prevent it . particularly , chronic cases do not show specific clinical and radiological signs for differential diagnosis . it should be included in the differential diagnosis of soft - tissue masses detected in patients with a history of a prior operation .
gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation . 
 inadvertent retention of a foreign body in the abdomen often requires another surgery . 
 this increases morbidity and mortality of the patient , cost of treatment , and medicolegal problems . 
 we are reporting case of a 45-year - old woman who was referred from periphery with acute pain in abdomen . 
 she had a surgical history of abdominal hysterectomy 3 years back , performed at another hospital . on clinical examination and investigation , twisted ovarian cyst was suspected . 
 that is a cystic mass further confirmed by abdominal computerized tomography ( ct ) . during laparotomy 
 , the cyst wall was opened incidentally which lead to the drainage of a large amount of dense pus . in between pus , 
 there was found retained surgical gauze that confirmed the diagnosis of gossypiboma .