Gossypiboma (textiloma) is a foreign body granuloma caused by a retained surgical sponge or gauze left in the abdomen after surgery. Acute presentation manifests as abscess or fistula, chronic as granulomatous mass. CT characteristically shows 'whirl sign' — spiral pattern of radiopaque marker within the sponge and surrounding inflammatory reaction. Medicolegally significant condition. Incidence reported between 1/1000 and 1/10000 abdominal surgeries.
Age Range
20-80
Peak Age
50
Gender
Equal
Prevalence
Rare
Gossypiboma causes two types of reaction from the interaction of retained sponge/gauze with surrounding tissues. Exudative type: acute inflammatory response — neutrophil infiltration, abscess formation, bacterial superinfection, and fistulization may develop. Fibrotic/granulomatous type: chronic foreign body reaction — foreign body giant cells, fibrosis, and calcification develop, creating mass effect. On CT, the radiopaque marker within the sponge (barium sulfate or lead thread) shows high density and appears as 'whirl sign' or linear hyperdensity. Sponge material may trap gas creating 'sponge pattern' — these gas bubbles result from degradation of non-absorbable material. Surrounding enhancing inflammatory wall reflects granuloma capsule.
Spiral or curvilinear high-density structure within mass on CT — characteristic spiral appearance of radiopaque marker within sponge material. Pathognomonic finding for gossypiboma that confirms diagnosis. Radiopaque marker may be barium sulfate-impregnated thread or lead strip.
Spiral or curvilinear high-density structure within mass — CT appearance of radiopaque marker (barium sulfate-impregnated thread) within sponge. Whirl sign is pathognomonic for gossypiboma. Marker typically shows >100 HU density creating conspicuous contrast within surrounding low-density sponge material.
Report Sentence
Spiral/curvilinear high-density structure (whirl sign) within intra-abdominal mass, consistent with gossypiboma (retained surgical sponge).
Small gas bubbles within mass ('sponge pattern'). Reflects air trapped in porous structure of sponge material or degradation gases. Gas within mass without abscess is a diagnostic clue for gossypiboma. Gas bubbles typically 1-5 mm and scattered pattern.
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Scattered small gas bubbles within mass (sponge pattern), consistent with gossypiboma.
Enhancing thick inflammatory wall surrounding mass (granuloma capsule). In chronic type, fibrotic capsule shows smooth and uniform enhancement. In acute type, irregular, thick, and heterogeneous enhancement — suggests abscess formation. Wall thickness varies 2-10 mm.
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Enhancing inflammatory wall surrounding mass, consistent with foreign body granuloma.
Mass shows heterogeneous signal on T2 MRI — sponge material low signal (fibrous and air), surrounding inflammatory tissue high signal. On T1, sponge material low-intermediate signal, surrounding granuloma capsule shows prominent post-contrast enhancement. Radiopaque marker appears as signal void in all sequences.
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Heterogeneous signal mass with areas of signal void and surrounding enhancing capsule on MRI, consistent with gossypiboma.
Hyperechoic mass with prominent acoustic shadowing on US. Sound waves are strongly reflected by sponge material and gas content creating posterior acoustic shadow. Diagnostic value is limited as finding is nonspecific — may be confused with stones, calcifications, or gas-containing structures.
Report Sentence
Hyperechoic mass with prominent acoustic shadowing on US; gossypiboma should be considered in the context of surgical history.
Calcification in mass wall in chronic gossypiboma. Dystrophic calcification develops in fibrotic capsule over years. Eggshell or coarse calcification pattern may be seen. Calcified gossypiboma is usually asymptomatic and discovered incidentally.
Report Sentence
Calcification in mass wall in chronic stage, consistent with chronic gossypiboma.
Criteria
Acute inflammatory response — presentation with abscess, fistula, or bowel obstruction. Appears in early postoperative period (weeks-months). Accompanied by fever, pain, and leukocytosis. CT shows rim enhancement, perifocal inflammation, and possible fistula tract.
Distinct Features
Early postoperative period, abscess/fistula, fever, leukocytosis, may require urgent surgery
Criteria
Chronic foreign body reaction — encapsulated granulomatous mass. Presentation incidentally or with mass effect years later. Low-grade inflammation, fibrosis, and calcification. CT shows well-defined, encapsulated mass, wall calcification may be present.
Distinct Features
Late presentation, encapsulated mass, calcification, incidental finding, elective surgery
Criteria
Sponge migrates into bowel lumen or adjacent organ. Transmural migration through bowel wall erosion with bowel obstruction or fistula formation. Bladder, vaginal, or cutaneous fistula reported. Rarest but most complicated type.
Distinct Features
Foreign body in bowel lumen, fistula tract, transmural migration findings
Distinguishing Feature
Intra-abdominal abscess lacks whirl sign and sponge pattern; gossypiboma has radiopaque marker (whirl sign) and surgical history
Distinguishing Feature
Desmoid tumor is homogeneous solid mass without gas or radiopaque marker; gossypiboma shows whirl sign and gas bubbles (sponge pattern)
Distinguishing Feature
Retroperitoneal liposarcoma contains fat-density components and soft tissue septa; gossypiboma is distinguished by radiopaque marker and surgical history
Distinguishing Feature
Mesenteric hematoma shows high density (50-70 HU) acutely with decreasing density over time; gossypiboma shows persistent whirl sign and sponge pattern findings
Urgency
urgentManagement
surgicalBiopsy
Not NeededFollow-up
specialist-referralSurgical removal should be planned when gossypiboma is diagnosed. Acute type (abscess/fistula) may require emergency surgery. Elective surgery is sufficient for chronic type. Correct documentation is critically important due to medicolegal implications. Strict adherence to surgical sponge counting protocols is the foundation of prevention. Biopsy is unnecessary — diagnosis is made by CT.
Gossypiboma requires surgical removal. Infection, abscess, fistula, and obstruction complications may develop. Has medicolegal significance. CT is the most sensitive diagnostic method.