Gossypiboma Mimicking an Ovarian Cyst, Discovered Two Years Post- Cesarean Section: A Case Report

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Sayed Masoud, Khattab Saeed Elkhazin MohamedAli, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4230639/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Aug, 2024 Read the published version in Patient Safety in Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract This case report presents a unique instance of gossypiboma, a surgical complication characterized by the unintentional retention of foreign objects such as gauze or sponges within the peritoneal cavity. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation. We describe the case of a 37-year-old multiparous female who presented with abdominal pain two years post-cesarean section, initially diagnosed with an ovarian cyst. However, intraoperative exploration revealed a gauze-filled cyst adherent to the ovary and jejunum, highlighting the diagnostic challenge and the need for meticulous surgical evaluation. This is the first reported case of gossypiboma in Sudan in 2024, emphasizing the global prevalence of this medical error. Root cause analysis and curriculum modifications are essential to address this issue. Multidisciplinary collaboration is crucial for successful management, emphasizing the importance of prompt recognition and intervention. This case underscores the diagnostic complexities and the necessity for enhanced protocols to prevent similar occurrences, advocating for improved communication among healthcare teams to ensure optimal patient outcomes Gossypiboma cesarean section intestinal obstruction Sudan Figures Figure 1 Figure 2 Figure 3 Introduction The terms gossypium (meaning cotton) and boma (meaning place of concealment) are the sources of what is known as gossypiboma ( 1 ). The phrase describes the unintentional placement of an operating field, cotton compress, or surgical sponge in the peritoneal cavity during operation ( 2 ). The intraperitoneal cavity is where gossypibomas are most frequently found ( 3 ). There is a 0.001–0.1% chance of leaving a foreign body in the surgical field after a single procedure, and 90% of the objects that are left behind are soft foreign bodies like gauze or surgical sponges ( 4 ). However, the real number of cases is still underestimated. Depending on the type of surgical intervention, the incidence of retained foreign bodies varies: 17.69% for caesarean sections, 16.33% for abdominal hysterectomy, and 13.54% for exploratory laparotomies in the acute abdomen ( 5 ). Patients with a higher body mass index, those undergoing emergent surgery, and circumstances where the surgical approach changes suddenly are more likely to have retained surgical items ( 6 ). The clinical manifestations are nonspecific, and the imaging results are frequently equivocal; therefore, diagnosis is typically challenging ( 7 ). The condition can manifest as intestinal blockage, peritonitis, adhesions, fistulas, abscesses, erosion into the gastrointestinal tract, or even passing through the rectum ( 7 ). Early identification of such a condition will guarantee prompt initiation of suitable care, lowering the morbidity and fatalities of these patients. In our case, a gossypiboma that mimicked an ovarian cyst was diagnosed two years after a caesarean section. Case presentation A 37-year-old female, gravida 10 para 10, had a previous emergent caesarean section after abdominal pain for one week. There was no fever, burning urination, or chest pain, and there was no history of ovarian cysts. On examination, she looked vitally stable; the abdomen was distended with mild generalized tenderness, and there was no guarding or rigidity; deep palpation revealed globular mass. Her total white blood cell count was 7.5/µL, haemoglobin was 14 g/dL, random blood glucose was 100 mg/dL, and abdominal ultrasound revealed a mass (10×10 cm²) that had been diagnosed as an ovarian cyst. The patient was optimized before being taken to the theatre. Under general anaesthesia, a midline incision was made with a scalpel and unipolar diathermy, subcutaneous tissue was cut, and the muscle was separated. A pink mass was identified; it was adherent to the ovary and jejunum with serosal attachment; it was firm in consistency and measured 10×10 cm². The adhesions were released by scissors. The mass was removed and the serosal layer was closed by an interrupted suture. Then the abdominal cavity was washed, after which the drain was placed and the wound was closed in layers. The macroscopic examination revealed a cyst filled with gauze, surrounded by mixed inflammatory cellular infiltration (Figs. 1 , 2 and 3 ). The histopathologist reported no malignant features. In the postoperative course, the patient received intravenous fluid and antibiotics for five days, and she recovered uneventfully from the surgery; she was discharged from the hospital five days after the surgery. Discussion This case is the first one reported in Sudan in 2024. And as far as we know the second Sudanese case ever reported in the literature. Despite many previous studies discussing gossypiboma as one of the medical errors occurring in surgery, there is still evidence of the prevalence of such errors worldwide. In Sudan, this issue may be addressed by conducting a root cause analysis to investigate all causes of this phenomenon and addressing them accordingly. Here, we analyse various aspects of our reported case by comparing it to similar cases reported in Africa over the past five years, in order to offer a broader contextual understanding of the situation. The presented case involves a 37-year-old multiparous female with a history of ten pregnancies and ten previous deliveries, presenting with abdominal pain and a history of an emergent caesarean section. Clinical examination, laboratory findings, and imaging studies led to the diagnosis of an ovarian cyst. However, subsequent surgical exploration revealed an unexpected and intriguing finding - a cyst filled with gauze adherent to the ovary and jejunum. The initial clinical presentation of the patient with abdominal pain and a palpable mass raised suspicion for an ovarian cyst, a common gynaecological condition. However, the unusual discovery during surgery emphasizes the importance of careful preoperative evaluation and thorough exploration in the operating room. The nature of the mass, filled with gauze, raises questions about its origin and how it became adherent to both the ovary and jejunum. A detailed history may provide clues, such as any previous surgical interventions, gynaecological procedures, or abdominal surgeries. The presence of gauze suggests the possibility of a retained surgical sponge, a rare but well-documented occurrence in the literature. The macroscopic examination, as illustrated in Figs. 1 , 2 , and 3 , shows the cystic structure surrounded by mixed inflammatory cellular infiltration. The absence of malignant features reported by the histopathologist is reassuring, ruling out neoplastic aetiologies. A similar case was reported in Sudan in 2023, involving a 24-year-old female with a history of emergency caesarean section. which was also presented after two years of the operation however it was complicated by the development of abdominal obstruction. the difference in age and presentation requires more care from the practitioner when confronted with a suspectable case of gossypiboma. ( 8 ) A similar African case of gossypiboma was reported in 2022, where a 31-year-old woman presented to the emergency room with similar complaints after three weeks of a cesarean section. Despite the age difference between these cases, the overall clinical prognosis is the same, as most patients show improvement after the foreign body is removed. ( 9 ) The management of such cases involves a multidisciplinary approach. The surgical team, in collaboration with gynecologists and general surgeons, must navigate the intricacies of the anatomy involved and carefully dissect adhesions to achieve complete excision. The adherence of the mass to the jejunum introduces an additional layer of complexity, requiring meticulous surgical skills to avoid inadvertent injuries. Postoperatively, the patient's recovery was uneventful, supported by intravenous fluids and antibiotics for five days. This successful outcome underscores the significance of prompt recognition and intervention in unexpected surgical findings. Contrary to our situation, the prolonged presence of gossypiboma can put pressure on adjacent organs, potentially causing them to perforate. This was highlighted in a recent study by Berhanu N. Alemu and Abraham G. Tiruneh, who documented a case of a patient experiencing abdominal discomfort one year after a cesarean section. Further investigation revealed that the discomfort was due to a gossypiboma leading to a perforated cecum. Timely recognition and intervention could significantly reduce the risk of such complications occurring. ( 10 ) This case and similar African-reported cases of gossypiboma underscore the diagnostic challenges that can arise in routine clinical practice. The unexpected discovery of a cyst filled with gauze during surgery emphasizes the need for thorough exploration and a high index of suspicion for retained surgical items. Multidisciplinary collaboration and careful surgical management are essential for optimal patient outcomes in such unusual cases. Future considerations may include a review of protocols to prevent retained surgical items and enhanced communication among healthcare teams to minimize such occurrences. Conclusion In conclusion, this case marks the first reported instance of gossypiboma in Sudan in 2024, highlighting the persistent global challenge of surgical errors and gossypiboma occurrences. Addressing this issue necessitates comprehensive root cause analysis, alongside revisions to healthcare practitioner training and hospital protocols to prioritize error prevention. The presented case, involving a multiparous female with an unexpected cyst filled with gauze, underscores the importance of meticulous preoperative evaluation and surgical exploration. Collaboration among surgical teams is crucial for successful management, especially in complex cases like adhesion-related complications. This case emphasizes the importance of timely intervention in unforeseen surgical findings, ensuring optimal patient outcomes. Declarations Ethical approval and Consent to participate: We confirm that all methods were carried out in accordance with relevant guidelines and regulations. the participants provided verbal and written informed consent. Participant was assured about the confidentiality of any obtained information. The data from this case was managed only by researchers in this study, Results will be used only for research and data cannot be traced back to their original sources. Consent to publication: Verbal and written informed consent to publication was obtained from the patient. Availability of data and materials: The data set used and/or analysed during the study are available from the corresponding author on reasonable request Conflict of interest: Authors declared no competing of interest. Funding: The study was self-funded Acknowledgment: We would like Dr. Mohammed Mahmmoud Fadelallah Eljack, Teaching assistant, Faculty of Medicine and Health Sciences, University of Bakht Alruda for his generous support and constructive comments. Author contribution: All authors participated in planning the study, data collection, results and discussion section. References Oncology DIN. Diagnostic Challenges in Patients With Tumors. 2003;21(19):3700–5. Varlas VN, Bors RG, Mastalier B, Balescu I, Bacalbasa N, Cirstoiu M mihaela. Gossypiboma , the Hidden Enemy of an Emergency Cesarean Hysterectomy — Case Report and Review of the Literature. 2023;1–15. Chopra S, Suri V, Sikka P, Aggarwal N. A Case Series on Gossypiboma - Varied Clinical Presentations and Their Management. 2015;9(12):12–4. Modrzejewski A, Kaźmierczak KM, Kowalik K, Grochal I. Surgical items retained in the abdominal cavity in diagnostic imaging tests : a series of 10 cases and literature review. 2023;264–9. Bodies RF. Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases. 2016;43(1):12–7. Gavri V, Cokan A, Lukman L, Arko D. Retained surgical needle and gauze after cesarean section and adnexectomy : a case report and literature review. 2018; Berhanu NA, Alemu BN, Tiruneh AG. Gossypiboma : A Case Series and Literature Review. :147–9. Bashir, S.I., Ali, Y.B., Ali, E.M. et al. Delayed intestinal obstruction from an unintentionally retained surgical gauze in a 24-year old woman two years after caesarean section: a case report. Patient Saf Surg 17 , 19 (2023). https://doi.org/10.1186/s13037-023-00371-y Munihire JB, Valimugighe MM, Martin NW. Mesenteric Textiloma early discovery in a 31-year-old female: A case report. International Journal of Surgery Case Reports. 2022 Aug;97:107439. doi:10.1016/j.ijscr.2022.107439 Alemu B, Tiruneh A. Gossypiboma: A case series and literature review. Ethiopian Journal of Health Sciences. 2020 Jan 1;30(1). doi:10.4314/ejhs.v30i1.19 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Aug, 2024 Read the published version in Patient Safety in Surgery → Version 1 posted Editorial decision: Revision requested 11 May, 2024 Reviews received at journal 18 Apr, 2024 Reviewers agreed at journal 15 Apr, 2024 Reviewers invited by journal 13 Apr, 2024 Editor assigned by journal 08 Apr, 2024 Submission checks completed at journal 08 Apr, 2024 First submitted to journal 07 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4230639","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":289035390,"identity":"b7de3d2d-ca52-4c50-b393-2e4704a7698b","order_by":0,"name":"HAGIR OSMAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYBACAwST+cABiQoQzdxArBa2xAMWZ0BaGInWwmN8oLINxCCgxZz9+MXHFRV10fyzewwO3JxXG83fDtTyo2IbTi2WPTnFhmfOHM6dcedYwcGZ247nzjjM2MDYc+Y2bocdyEmTbGw7kNtwI3nDYcltx3IbgFqYGdvwaDn/Jv1nY1td7vwbCQaH/845ljufoJYb6ccYG9uYczfcSDE4INlQk7uBsJY3zJINQL9svJGWcEDi2IHcjUAtB/H65Xz6w48NFXW5824kH/4gUQNknD988MGPCtxagNFhgMw7DCYP4FEPBOwPkHl1+BWPglEwCkbBiAQAQTVrA8g1DccAAAAASUVORK5CYII=","orcid":"","institution":"University of Bakht Alruda","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"HAGIR","middleName":"","lastName":"OSMAN","suffix":""},{"id":289035392,"identity":"6b2b3996-e004-4f61-a5e2-0466471c1e27","order_by":1,"name":"M. Sayed Masoud","email":"","orcid":"","institution":"University of Bakht Alruda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"M.","middleName":"Sayed","lastName":"Masoud","suffix":""},{"id":289035393,"identity":"9787191a-3f99-4bf3-bdfb-22f197e9c304","order_by":2,"name":"Khattab Saeed Elkhazin MohamedAli","email":"","orcid":"","institution":"University of Shendi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khattab","middleName":"Saeed Elkhazin","lastName":"MohamedAli","suffix":""},{"id":289035395,"identity":"44a2d204-9faf-47ac-8f6d-d4494534d709","order_by":3,"name":"Hiba Awadelkareem Osman Fadl","email":"","orcid":"","institution":"Al-Neelain University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hiba","middleName":"Awadelkareem Osman","lastName":"Fadl","suffix":""},{"id":289035396,"identity":"a792f285-0198-4545-9850-e0c2ee6f5f22","order_by":4,"name":"Abdelrahman Hamza","email":"","orcid":"","institution":"Al-Neelain University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdelrahman","middleName":"","lastName":"Hamza","suffix":""},{"id":289035397,"identity":"f086498d-4a84-47a6-b42f-009da7778c0a","order_by":5,"name":"Hind Abashar Mohamed Basheer","email":"","orcid":"","institution":"University of Bakht Alruda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hind","middleName":"Abashar Mohamed","lastName":"Basheer","suffix":""},{"id":289035399,"identity":"dd601c37-d9b8-43b2-9cf4-d52f00c4b23d","order_by":6,"name":"Mohamed alfaraja","email":"","orcid":"","institution":"University of Bakht Alruda","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"alfaraja","suffix":""}],"badges":[],"createdAt":"2024-04-07 09:29:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4230639/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4230639/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13037-024-00407-x","type":"published","date":"2024-08-16T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":54596332,"identity":"6468fe71-ecf6-496d-b4e7-c547b21acf00","added_by":"auto","created_at":"2024-04-12 19:03:50","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":128084,"visible":true,"origin":"","legend":"\u003cp\u003epostoperative view of gossypiboma.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4230639/v1/c59df8e57c2d975d4a2ca9ee.jpeg"},{"id":54597062,"identity":"6b6bd82e-ce5f-4e6c-b05a-f2dea62bb799","added_by":"auto","created_at":"2024-04-12 19:11:50","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":363222,"visible":true,"origin":"","legend":"\u003cp\u003eGossypiboma after taken out.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4230639/v1/5d48d7eaed393910d7931186.jpeg"},{"id":54597506,"identity":"ce5c4a6b-f157-4adb-955c-a0b3ebb18e0a","added_by":"auto","created_at":"2024-04-12 19:19:50","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":67251,"visible":true,"origin":"","legend":"\u003cp\u003eUnfolded retained surgical gauze after taken out.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4230639/v1/d234ab9aa9e074799a1a4cd2.jpeg"},{"id":63071023,"identity":"cb5aa1e2-e059-4db4-a9a9-c672b92fe02e","added_by":"auto","created_at":"2024-08-22 20:02:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824239,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4230639/v1/0fe9fbf9-ace5-4406-9c3d-04455b9045e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gossypiboma Mimicking an Ovarian Cyst, Discovered Two Years Post- Cesarean Section: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe terms gossypium (meaning cotton) and boma (meaning place of concealment) are the sources of what is known as gossypiboma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The phrase describes the unintentional placement of an operating field, cotton compress, or surgical sponge in the peritoneal cavity during operation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The intraperitoneal cavity is where gossypibomas are most frequently found (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). There is a 0.001\u0026ndash;0.1% chance of leaving a foreign body in the surgical field after a single procedure, and 90% of the objects that are left behind are soft foreign bodies like gauze or surgical sponges (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, the real number of cases is still underestimated. Depending on the type of surgical intervention, the incidence of retained foreign bodies varies: 17.69% for caesarean sections, 16.33% for abdominal hysterectomy, and 13.54% for exploratory laparotomies in the acute abdomen (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Patients with a higher body mass index, those undergoing emergent surgery, and circumstances where the surgical approach changes suddenly are more likely to have retained surgical items (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The clinical manifestations are nonspecific, and the imaging results are frequently equivocal; therefore, diagnosis is typically challenging (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The condition can manifest as intestinal blockage, peritonitis, adhesions, fistulas, abscesses, erosion into the gastrointestinal tract, or even passing through the rectum (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Early identification of such a condition will guarantee prompt initiation of suitable care, lowering the morbidity and fatalities of these patients. In our case, a gossypiboma that mimicked an ovarian cyst was diagnosed two years after a caesarean section.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 37-year-old female, gravida 10 para 10, had a previous emergent caesarean section after abdominal pain for one week. There was no fever, burning urination, or chest pain, and there was no history of ovarian cysts. On examination, she looked vitally stable; the abdomen was distended with mild generalized tenderness, and there was no guarding or rigidity; deep palpation revealed globular mass. Her total white blood cell count was 7.5/\u0026micro;L, haemoglobin was 14 g/dL, random blood glucose was 100 mg/dL, and abdominal ultrasound revealed a mass (10\u0026times;10 cm\u0026sup2;) that had been diagnosed as an ovarian cyst. The patient was optimized before being taken to the theatre. Under general anaesthesia, a midline incision was made with a scalpel and unipolar diathermy, subcutaneous tissue was cut, and the muscle was separated. A pink mass was identified; it was adherent to the ovary and jejunum with serosal attachment; it was firm in consistency and measured 10\u0026times;10 cm\u0026sup2;. The adhesions were released by scissors. The mass was removed and the serosal layer was closed by an interrupted suture. Then the abdominal cavity was washed, after which the drain was placed and the wound was closed in layers. The macroscopic examination revealed a cyst filled with gauze, surrounded by mixed inflammatory cellular infiltration (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The histopathologist reported no malignant features. In the postoperative course, the patient received intravenous fluid and antibiotics for five days, and she recovered uneventfully from the surgery; she was discharged from the hospital five days after the surgery.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eThis case is the first one reported in Sudan in 2024. And as far as we know the second Sudanese case ever reported in the literature. Despite many previous studies discussing gossypiboma as one of the medical errors occurring in surgery, there is still evidence of the prevalence of such errors worldwide. In Sudan, this issue may be addressed by conducting a root cause analysis to investigate all causes of this phenomenon and addressing them accordingly. Here, we analyse various aspects of our reported case by comparing it to similar cases reported in Africa over the past five years, in order to offer a broader contextual understanding of the situation. The presented case involves a 37-year-old multiparous female with a history of ten pregnancies and ten previous deliveries, presenting with abdominal pain and a history of an emergent caesarean section. Clinical examination, laboratory findings, and imaging studies led to the diagnosis of an ovarian cyst. However, subsequent surgical exploration revealed an unexpected and intriguing finding - a cyst filled with gauze adherent to the ovary and jejunum. The initial clinical presentation of the patient with abdominal pain and a palpable mass raised suspicion for an ovarian cyst, a common gynaecological condition. However, the unusual discovery during surgery emphasizes the importance of careful preoperative evaluation and thorough exploration in the operating room. The nature of the mass, filled with gauze, raises questions about its origin and how it became adherent to both the ovary and jejunum. A detailed history may provide clues, such as any previous surgical interventions, gynaecological procedures, or abdominal surgeries. The presence of gauze suggests the possibility of a retained surgical sponge, a rare but well-documented occurrence in the literature. The macroscopic examination, as illustrated in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, shows the cystic structure surrounded by mixed inflammatory cellular infiltration. The absence of malignant features reported by the histopathologist is reassuring, ruling out neoplastic aetiologies. A similar case was reported in Sudan in 2023, involving a 24-year-old female with a history of emergency caesarean section. which was also presented after two years of the operation however it was complicated by the development of abdominal obstruction. the difference in age and presentation requires more care from the practitioner when confronted with a suspectable case of gossypiboma. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) A similar African case of gossypiboma was reported in 2022, where a 31-year-old woman presented to the emergency room with similar complaints after three weeks of a cesarean section. Despite the age difference between these cases, the overall clinical prognosis is the same, as most patients show improvement after the foreign body is removed. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) The management of such cases involves a multidisciplinary approach. The surgical team, in collaboration with gynecologists and general surgeons, must navigate the intricacies of the anatomy involved and carefully dissect adhesions to achieve complete excision. The adherence of the mass to the jejunum introduces an additional layer of complexity, requiring meticulous surgical skills to avoid inadvertent injuries. Postoperatively, the patient's recovery was uneventful, supported by intravenous fluids and antibiotics for five days. This successful outcome underscores the significance of prompt recognition and intervention in unexpected surgical findings. Contrary to our situation, the prolonged presence of gossypiboma can put pressure on adjacent organs, potentially causing them to perforate. This was highlighted in a recent study by Berhanu N. Alemu and Abraham G. Tiruneh, who documented a case of a patient experiencing abdominal discomfort one year after a cesarean section. Further investigation revealed that the discomfort was due to a gossypiboma leading to a perforated cecum. Timely recognition and intervention could significantly reduce the risk of such complications occurring. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) This case and similar African-reported cases of gossypiboma underscore the diagnostic challenges that can arise in routine clinical practice. The unexpected discovery of a cyst filled with gauze during surgery emphasizes the need for thorough exploration and a high index of suspicion for retained surgical items. Multidisciplinary collaboration and careful surgical management are essential for optimal patient outcomes in such unusual cases. Future considerations may include a review of protocols to prevent retained surgical items and enhanced communication among healthcare teams to minimize such occurrences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this case marks the first reported instance of gossypiboma in Sudan in 2024, highlighting the persistent global challenge of surgical errors and gossypiboma occurrences. Addressing this issue necessitates comprehensive root cause analysis, alongside revisions to healthcare practitioner training and hospital protocols to prioritize error prevention. The presented case, involving a multiparous female with an unexpected cyst filled with gauze, underscores the importance of meticulous preoperative evaluation and surgical exploration. Collaboration among surgical teams is crucial for successful management, especially in complex cases like adhesion-related complications. This case emphasizes the importance of timely intervention in unforeseen surgical findings, ensuring optimal patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and Consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that all methods were carried out in accordance with relevant guidelines and regulations. the participants provided verbal and written informed consent. Participant was assured about the confidentiality of any obtained information. The data from this case was managed only by researchers in this study, Results will be used only for research and data cannot be traced back to their original sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal and written informed consent to publication was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set used and/or analysed during the study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declared no competing of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was self-funded\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like Dr. Mohammed Mahmmoud Fadelallah Eljack, Teaching assistant, Faculty of Medicine and Health Sciences, University of Bakht Alruda for his generous support and constructive comments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in planning the study, data collection, results and discussion section.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOncology DIN. Diagnostic Challenges in Patients With Tumors. 2003;21(19):3700\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eVarlas VN, Bors RG, Mastalier B, Balescu I, Bacalbasa N, Cirstoiu M mihaela. Gossypiboma , the Hidden Enemy of an Emergency Cesarean Hysterectomy \u0026mdash; Case Report and Review of the Literature. 2023;1\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eChopra S, Suri V, Sikka P, Aggarwal N. A Case Series on Gossypiboma - Varied Clinical Presentations and Their Management. 2015;9(12):12\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eModrzejewski A, Kaźmierczak KM, Kowalik K, Grochal I. Surgical items retained in the abdominal cavity in diagnostic imaging tests : a series of 10 cases and literature review. 2023;264\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBodies RF. Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases. 2016;43(1):12\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGavri V, Cokan A, Lukman L, Arko D. Retained surgical needle and gauze after cesarean section and adnexectomy : a case report and literature review. 2018; \u003c/li\u003e\n\u003cli\u003eBerhanu NA, Alemu BN, Tiruneh AG. Gossypiboma : A Case Series and Literature Review. :147\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBashir, S.I., Ali, Y.B., Ali, E.M. \u003cem\u003eet al.\u003c/em\u003e Delayed intestinal obstruction from an unintentionally retained surgical gauze in a 24-year old woman two years after caesarean section: a case report. \u003cem\u003ePatient Saf Surg\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 19 (2023). https://doi.org/10.1186/s13037-023-00371-y\u003c/li\u003e\n\u003cli\u003eMunihire JB, Valimugighe MM, Martin NW. Mesenteric Textiloma early discovery in a 31-year-old female: A case report. International Journal of Surgery Case Reports. 2022 Aug;97:107439. doi:10.1016/j.ijscr.2022.107439 \u003c/li\u003e\n\u003cli\u003eAlemu B, Tiruneh A. Gossypiboma: A case series and literature review. Ethiopian Journal of Health Sciences. 2020 Jan 1;30(1). doi:10.4314/ejhs.v30i1.19 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"patient-safety-in-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psis","sideBox":"Learn more about [Patient Safety in Surgery](http://pssjournal.biomedcentral.com/)","snPcode":"13037","submissionUrl":"https://submission.nature.com/new-submission/13037/3","title":"Patient Safety in Surgery","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gossypiboma, cesarean section, intestinal obstruction, Sudan","lastPublishedDoi":"10.21203/rs.3.rs-4230639/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4230639/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis case report presents a unique instance of gossypiboma, a surgical complication characterized by the unintentional retention of foreign objects such as gauze or sponges within the peritoneal cavity. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation. We describe the case of a 37-year-old multiparous female who presented with abdominal pain two years post-cesarean section, initially diagnosed with an ovarian cyst. However, intraoperative exploration revealed a gauze-filled cyst adherent to the ovary and jejunum, highlighting the diagnostic challenge and the need for meticulous surgical evaluation. This is the first reported case of gossypiboma in Sudan in 2024, emphasizing the global prevalence of this medical error. Root cause analysis and curriculum modifications are essential to address this issue. Multidisciplinary collaboration is crucial for successful management, emphasizing the importance of prompt recognition and intervention. This case underscores the diagnostic complexities and the necessity for enhanced protocols to prevent similar occurrences, advocating for improved communication among healthcare teams to ensure optimal patient outcomes\u003c/p\u003e","manuscriptTitle":"Gossypiboma Mimicking an Ovarian Cyst, Discovered Two Years Post- Cesarean Section: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 19:03:45","doi":"10.21203/rs.3.rs-4230639/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-12T02:05:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-19T02:12:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46feedff-7470-4e17-b4e8-a0583f21886c","date":"2024-04-15T14:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-13T13:38:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-09T00:09:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-08T07:08:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Patient Safety in Surgery","date":"2024-04-07T09:23:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"patient-safety-in-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psis","sideBox":"Learn more about [Patient Safety in Surgery](http://pssjournal.biomedcentral.com/)","snPcode":"13037","submissionUrl":"https://submission.nature.com/new-submission/13037/3","title":"Patient Safety in Surgery","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c2daa5ff-0ffb-4be0-8484-604c416721e3","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-22T19:30:22+00:00","versionOfRecord":{"articleIdentity":"rs-4230639","link":"https://doi.org/10.1186/s13037-024-00407-x","journal":{"identity":"patient-safety-in-surgery","isVorOnly":false,"title":"Patient Safety in Surgery"},"publishedOn":"2024-08-16 15:56:59","publishedOnDateReadable":"August 16th, 2024"},"versionCreatedAt":"2024-04-12 19:03:45","video":"","vorDoi":"10.1186/s13037-024-00407-x","vorDoiUrl":"https://doi.org/10.1186/s13037-024-00407-x","workflowStages":[]},"version":"v1","identity":"rs-4230639","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4230639","identity":"rs-4230639","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}