Journal of Clinical Case Reports

Pelvic Gossypiboma Diagnosed at the Time of Radical Prostatectomy 30 Years after Inguinal Hernioplasty

Abstract

Riccardo Campi, Francesco Sessa, Marco Carini, Girolamo Morelli, Giampaolo Siena and Andrea Minervini

Study Background: The term “Gossypiboma” is used to define a mass inside the body consisting of cotton matrix with surrounding foreign body reaction. Gossypibomas may be clinically silent or present in the postoperative period with a broad range of symptoms, mimicking a mass or abscess both clinically and radiologically. Although extremely rare, their precise incidence is unknown and probably underestimated.

Methods: Herein we describe the case of a 71-year-old man with a large pelvic Gossypiboma diagnosed at the time of radical prostatectomy (RP) 30 years after inguinal hernioplasty.

Results: Clinical stage of prostate cancer was cT2N1M0. Preoperative CT scan showed a 3.0 cm × 5.0 cm mass of unknown nature with inhomogeneous uptake of contrast medium close to the right iliac vessels suspected for lymph node metastasis. For this reason, an open approach was chosen for RP and extended lymph node dissection. A solid mass, firmly adherent to the surrounding tissues, was carefully dissected from the iliac vessels and removed en-block. The intraoperative examination revealed a left-behind surgical sponge. No surgical complications were recorded. At definitive histopathological analysis, a Gleason 4+4 pT3b N0 (n=28) prostatic acinar adenocarcinoma was found and a retained surgical sponge with a peripheral fibrous pseudocapsule, resulting from an inflammatory foreign-body reaction, were found. Surgical margins were negative for malignancy.

Conclusion: Although more infrequent with the advent of standardized surgical counting, gossypibomas can still occur in surgical practice, being either asymptomatic occasional findings or, if not promptly diagnosed, lifethreatening causes of acute abdomen. In our case, the radiological appearance of the pelvic gossypiboma simulated a malignant lymphadenopathy and changed our surgical strategy from the robotic to the open approach. Overall, our case highlights how prevention represents the key aspect to ensure the maximal safety of surgical patients.