Lumbar gossypiboma: imaging features

Abstract

Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess.

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

“…The literature reports cases of surgical textilomas that were diagnosed after 13 days to 40 years (14,15). Our cases were diagnosed after 3, 19, and 5 years had passed since the initial operation.…”

“…Foreign bodies and peripheral inflammation may grow significantly and thus reveal new clinical evidence through mass development (2,12,15). The three cases presented herein were of this second form.…”

“…The mechanism for infection at the surgical site is based on the fact that the retained sponge acts as an incubation plate and leads to a superinfection, which in turn results in fistulisation. Septic collection in exudative forms and abscesses has been attributed to early superinfections (2,12,15). All of our cases were diagnosed late, and none presented with exudative reactions.…”

“…Kuwashima et al have published MRI findings of two textiloma cases. The authors concluded that the surgical textile products contained serosanguineous fluid and high protein concentrations (8,15,(22)(23)(24)(25)(26)(27). MRI showed the laminectomy defect at L5 (Case 1 and Case 3) and at L3-4-5 (Case 2) and a mass lesion in the posterior paraspinal region at these levels.…”

“…In relation to the recent increase in complex spine surgeries, the number of gauze bandages and pads that are used in such surgeries has also increased (9,10,(12)(13)(14)(15)(16)(17)(18). Among these textile products, surgical sponges are the most commonly used.…”