Textiloma thirteen years after nephrectomy

Abstract

Background: Large foreign body granulomas and pseudotumors resulting from retained surgical material or stitches (textilomas) are extremely rare and their clinical characteristics depend on the anatomic site that they occur. Objective: We present the case of a 77-year-old female with a history of right donor nephrectomy for renal transplantation 13 years before her admission, complaining of a swollen right leg and a painful right groin during the previous 3 weeks. Venous duplex sonography, CT and MRI scans depicted a right retroperitoneal polycystic mass (132x75x55 mm), which extended beyond the right inguinal ligament to the right femoral ring. The mass was adjacent to and compressed the right iliac vessels. As the scans failed to provide a diagnosis, the patient underwent exploratory surgery. The mass, which originated from the right iliopsoas muscle and extended through the femoral ring towards the right thigh, was dissected free of the adjacent structures. The cultures of the liquid content of the mass were negative for the presence of microorganisms and the pathology report recorded foreign body reaction. The recovery of the patient was uneventful, the edema of her right limb subsided and she was discharged 7 days after the initial surgery. Conclusion: Textilomas are a very rare entity with many possible manifestations depending on the anatomic site of their formation and thus represent a diagnostic challenge. In some cases, the correct diagnosis can only be confirmed after a surgical procedure.