A 12-year-old chronic form textiloma after revision surgery for infected spinal instrumentation

Abstract

Retained surgical gauze and the surrounding foreign body reaction constitute a mass referred to as a textiloma. Textiloma has acute and chronic forms; the acute form is symptomatic in the early postoperative period and the chronic form may be asymptomatic or display mild and nonspecific symptoms. Usually, textiloma after previously infected surgery has acute forms. We report here on a case of a 46-year-old male who had retained surgical gauze for 12 years. The patient had received revision surgery for infected spinal instrumentation 12-years previously and had no specific symptom after surgery. One month prior to the present admission, the patient experienced low back pain and left thigh pain. Based on the prior operative history and present imaging results, the patient was diagnosed with an abscess due to a foreign body reaction. The patient underwent surgery, which discovered retained gauze with granuloma. This case is the third longest reported case after entire spinal surgery and the longest time of textiloma after previously infected spine surgery.

Gauze for concern: A Case Report and systematic review of delayed presentation of paraspinal textiloma

“…CT shows a complex, iso-or hyperdense mass with hyperdense nidus, and pathognomonic trapped foci of gas within a spongiform or mesh-like matrix (30). Hence, CT is considered by a few authors to be the modality of choice in diagnosing textiloma (19,20).…”

Abscess due to textiloma (gossypiboma: Retained surgical cottonoid)

“…[ 3 4 7 ] However, spinal epidural abscesses are rarely attributed to infected, retained surgical sponges (textiloma or gossypiboma) that have inadvertently been left behind in an operative field. [ 6 ] Here, we present a case of a 53-year-old female, who previously had two posterior lumbar spinal procedures at an outside hospital consisting of an L5-S1 discectomy 11 years ago and an L4-L5 laminectomy 2 years ago. She presented with an acute epidural spinal abscess L4-S1 attributed to a magnetic resonance imaging (MRI) and surgically documented textiloma/gossypiboma (infected retained sponge).…”