Gossypiboma Following Cesarean Section Presenting as Bilateral Abdominal Abscesses: A Case Report.

Abstract

<b>Background</b>: Gossypiboma is an uncommon postoperative complication caused by the retention of surgical materials, most frequently sponges, and is associated with substantial morbidity and medicolegal consequences. Despite a reduction in reported incidence, diagnosis remains challenging due to its nonspecific clinical presentation. <b>Case Presentation</b>: We present the case of a 36-year-old woman who presented with a one-week history of throbbing abdominal pain in the umbilical and left lumbar regions, associated with fetid leukorrhea. Her medical history included an appendectomy, a recent cesarean section performed two months prior, and pregnancy-induced hypertension. Initial computed tomography revealed bilateral subcutaneous and intra-abdominal collections with air bubbles and hyperdense linear structures, raising suspicion of abdominal abscesses. Gynecological evaluation excluded pelvic inflammatory pathology. Exploratory laparotomy identified bilateral pseudotumoral masses with complex adhesions involving intestinal loops and omentum, without evidence of gynecologic infection, prompting transfer to a tertiary care center. Repeat imaging confirmed bilateral flank abscesses. Surgical reintervention revealed retained surgical sponges within both abscess cavities, which were successfully removed, followed by evacuation, lavage, and drainage. Postoperative evolution was favorable under broad-spectrum antibiotic therapy, with complete clinical and biological recovery. <b>Conclusions</b>: This case highlights the diagnostic challenge of gossypiboma, particularly when mimicking intra-abdominal abscesses or adhesion syndromes. A high index of suspicion is required in patients with prior surgical history and atypical postoperative presentations, as early recognition and prompt surgical management are essential to reduce morbidity and medicolegal consequences.