Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma

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It is a rare but serious iatrogenic complication that may remain asymptomatic for years. Case Presentation We report a case of a 38-year-old woman with a history of open ovarian cystectomy 15 years earlier, presenting with persistent abdominal pain. Imaging revealed a complex pelvic mass with abscess formation and enteric fistula. Despite interventional drainage and antibiotic therapy, the patient developed signs of sepsis. Endoscopic evaluation revealed a retained surgical textile in the rectum, which was extracted. The patient subsequently developed generalized peritonitis and underwent emergency laparotomy revealing two retained textilomas and multiple intestinal perforations. Despite aggressive surgical intervention, the patient succumbed to septic shock on postoperative day one. Conclusion Textiloma should be considered in patients with atypical abdominal masses and previous surgical history. Preventive strategies and early recognition are critical to avoid fatal outcomes. 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F1000Research 2025, 14 :947 ( https://doi.org/10.12688/f1000research.169895.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] Rakia Siala 1 , Mohamed Ali Mseddi https://orcid.org/0000-0002-5107-2122 1 , Haythem Yacoub 2 , [...] EYA AZOUZ 3 , Hajer Hassine https://orcid.org/0000-0002-4077-8373 2 , Chaima Yacoubi https://orcid.org/0000-0002-5174-2624 1 , Meriem Hsairi https://orcid.org/0000-0002-8803-6926 1 , Fatma Trifa https://orcid.org/0009-0003-0710-7409 4 , Radhia Boubaker 4 , Nesrine Krifa https://orcid.org/0009-0007-5089-3598 2 , Sallemi Karim 1 , Emna Khemakhem 1 , Abdelwaheb Mghirbi 4 , Amal Bhira 4 , Yosra Yahia 4 , Souhir Mestiri 2 , Rami Guizani https://orcid.org/0000-0001-6083-0880 1 , Brahim Ghariani 1 , Karim Sassi 1 , Hamida Maghraoui 4 , Hela Kchir 2 , Mohamed Ben Slima 1 Rakia Siala 1 , Mohamed Ali Mseddi https://orcid.org/0000-0002-5107-2122 1 , [...] Haythem Yacoub 2 , EYA AZOUZ 3 , Hajer Hassine https://orcid.org/0000-0002-4077-8373 2 , Chaima Yacoubi https://orcid.org/0000-0002-5174-2624 1 , Meriem Hsairi https://orcid.org/0000-0002-8803-6926 1 , Fatma Trifa https://orcid.org/0009-0003-0710-7409 4 , Radhia Boubaker 4 , Nesrine Krifa https://orcid.org/0009-0007-5089-3598 2 , Sallemi Karim 1 , Emna Khemakhem 1 , Abdelwaheb Mghirbi 4 , Amal Bhira 4 , Yosra Yahia 4 , Souhir Mestiri 2 , Rami Guizani https://orcid.org/0000-0001-6083-0880 1 , Brahim Ghariani 1 , Karim Sassi 1 , Hamida Maghraoui 4 , Hela Kchir 2 , Mohamed Ben Slima 1 PUBLISHED 19 Sep 2025 Author details Author details 1 General surgery “B” department, Rabta Hospital, Tunis, Tunis, Tunisia 2 Gastroenterology “B” Department, Rabta Hospital, Tunis, Tunis, Tunisia 3 Medical Imaging Department, Rabta Hospital, Tunis, Tunis, Tunisia 4 Emergency department, Rabta Hospital, Tunis, Tunis, Tunisia Rakia Siala Roles: Conceptualization, Supervision, Validation Mohamed Ali Mseddi Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Haythem Yacoub Roles: Resources, Supervision EYA AZOUZ Roles: Resources, Supervision Hajer Hassine Roles: Supervision Chaima Yacoubi Roles: Supervision Meriem Hsairi Roles: Supervision Fatma Trifa Roles: Supervision Radhia Boubaker Roles: Supervision Nesrine Krifa Roles: Supervision Sallemi Karim Roles: Supervision Emna Khemakhem Roles: Supervision Abdelwaheb Mghirbi Roles: Supervision Amal Bhira Roles: Supervision Yosra Yahia Roles: Supervision Souhir Mestiri Roles: Supervision Rami Guizani Roles: Supervision Brahim Ghariani Roles: Supervision Karim Sassi Roles: Supervision Hamida Maghraoui Roles: Supervision Hela Kchir Roles: Supervision Mohamed Ben Slima Roles: Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Textiloma refers to a retained surgical textile material within the body after surgery. It is a rare but serious iatrogenic complication that may remain asymptomatic for years. Case Presentation We report a case of a 38-year-old woman with a history of open ovarian cystectomy 15 years earlier, presenting with persistent abdominal pain. Imaging revealed a complex pelvic mass with abscess formation and enteric fistula. Despite interventional drainage and antibiotic therapy, the patient developed signs of sepsis. Endoscopic evaluation revealed a retained surgical textile in the rectum, which was extracted. The patient subsequently developed generalized peritonitis and underwent emergency laparotomy revealing two retained textilomas and multiple intestinal perforations. Despite aggressive surgical intervention, the patient succumbed to septic shock on postoperative day one. Conclusion Textiloma should be considered in patients with atypical abdominal masses and previous surgical history. Preventive strategies and early recognition are critical to avoid fatal outcomes. READ ALL READ LESS Keywords Textiloma, intestinal perforation, peritonitis Corresponding Author(s) Mohamed Ali Mseddi ( [email protected] ) Close Corresponding author: Mohamed Ali Mseddi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Siala R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Siala R, Mseddi MA, Yacoub H et al. Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.12688/f1000research.169895.1 ) First published: 19 Sep 2025, 14 :947 ( https://doi.org/10.12688/f1000research.169895.1 ) Latest published: 04 Dec 2025, 14 :947 ( https://doi.org/10.12688/f1000research.169895.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Despite standardized operative protocols and heightened vigilance regarding surgical sponge counts, retained surgical items, particularly textiloma, continue to occur. Alarmingly, this complication persists even in high-resource healthcare settings. In Canada, surgical wards have reported that retained surgical items account for approximately 12% to 18% of surgical complications. 1 Whereas English authorities reported that gossypibomas represent 21% of never events. 2 It is a fearsome complication as it is often labeled as medical negligence 3 and its consequences might cost the patient his life and the surgeon his professional reputation. 4 Case-report A 38-year-old nulliparous woman with a history of open ovarian cystectomy 15 years prior was referred to our department for evaluation of abdominal pain evolving over one month, with nocturnal predominance. She denied smoking, alcohol use, or any known allergies. On admission, her vital signs were stable. Clinical examination revealed a patient with altered general condition (ECOG Performance Status = 2). Abdominal examination noted a healed sub-umbilical median laparotomy scar. No palpable mass, tenderness, or peritoneal signs were present. Laboratory studies showed elevated C-reactive protein (CRP) at 80.5 mg/L and hypokalemia (K + = 2.7 mmol/L), with preserved renal and hepatic function. The remainder of the biochemical and hematological workup was unremarkable. Abdominal ultrasound identified a suprauterine ovoid pelvic mass (9 × 8 × 4.2 cm), hypoechoic peripherally with a hyperechoic center and posterior acoustic shadowing, located between the transversalis fascia and anterior parietal peritoneum. Abdominal computed tomography (CT) demonstrated a 9 × 8 × 5 cm pelvic-abdominal mass, anterior to the bladder and abutting the anterior abdominal wall. The lesion contained heterogeneous fluid and air with peripheral contrast enhancement, associated with agglutinated intestinal loops and multiple enlarged locoregional lymph nodes ( Figure 1 ). There was concern for enteric fistula and communication with the urinary bladder. Figure 1. Axial scans of the abdomen and pelvis without contrast injection (images C and D) and at portal vein phase (A, B) showing a collection above the bladder in the preperitoneal space with faecal content measuring 52x27 mm (A) communicating with the lumen of an ileal loop via a 16 mm fistulous tract (B) associated with regular parietal thickening of the nearby ileal loops (arrow) and infiltration of the peritoneal fat in contact (blue arrowhead) of a reactive nature. Images C and D show two intraluminal foreign bodies in the ileal loops, spontaneously dense and heterogeneous, forming air bubbles (white arrowheads). Empirical broad-spectrum antibiotic therapy with imipenem was initiated. On day 3, a radiologically guided percutaneous drainage of the collection was performed ( Figure 2 ), yielding a small volume of fecal material. Despite drainage, CRP rose to 140 mg/L and stabilized at 120 mg/L. Figure 2. Three days after the first scan, CT-guided drainage of the collection was indicated and performed ( Figure 2 ). Axial slices after portal vein injection (A, B) show a drain in place with its distal end coiled in the collection (A), a stable appearance of the digestive wall thickening and the peritoneal reaction in the surrounding area previously described (B). Axial slices of the abdominal-pelvic CT scan without injection of contrast medium C and D show the migration of the two intraluminal foreign bodies from the ileal loops visualised on the previous scan. The first foreign body is found in the caecum (image C, white arrow) and the second in the left colon with its distal end in the sigmoid colon (image D, yellow arrow). Entero-MRI revealed circumferential thickening of the terminal ileum extending over 20 cm, centered on a subparietal collection (78 × 59 × 55 mm) with a drain in place. A large fistulous communication with an adjacent intestinal loop was evident, with additional blind-ending fistulae and a spiculated border. On day 13, the patient reported a sensation of rectal fullness. Proctological examination revealed a textile foreign body soiled with feces. An abdominal CT scan was ordered. It confirmed the progressive migration of both foreign bodies along the colon, one reaching the transverse colon and the other advancing to the rectosigmoid with distal externalization through the anal margin ( Figure 3 ). Rigid rectoscopy on day 18 confirmed retained gauze embedded in the rectal mucosa approximately 20 cm from the anal verge ( Figure 4 ), which was extracted under visual guidance ( Figure 5 ). Following extraction, the patient developed acute diffuse abdominal pain and guarding. Figure 3. Images from the abdominal-pelvic CT scan performed 11 days after drainage: A- Axial CT scan after contrast injection at portal phase showing migration to the transverse colon of the intraluminal foreign body previously visualised at the caecal level (white arrow). There is also evidence of regular pancolic wall thickening (white arrowhead) and a stable inflammatory complex in the small bowel loops and surrounding fat. B- Sagittal reconstruction in the portal phase partially illustrating the second foreign body, which has continued to migrate to the rectosigmoid colon (previously in the left colon), the distal end of which is externalised through the anal margin (yellow arrow). Figure 4. An endoscopic view of intra luminal textiloma, being externalised. Figure 5. Retrieved textiloma. Emergency CT imaging revealed pneumoperitoneum, circumferential rectosigmoid wall thickening with submucosal edema, suspected parietal defect (6 cm), increased supravesical collection size, and new peritoneal fluid ( Figure 6 ). Figure 6. Axial images from the last scan performed approximately 3 weeks after the first scan showing: In the pulmonary window (A and B), moderate pneumoperitoneum above and below the mesocolon (blue arrowheads). Image C shows a regular circumferential thickening of the rectosigmoid junction (yellow arrow) silhouetted by extra-digestive air bubbles without any formally identifiable parietal defect. In image D, there is a partial regression of the supravesical collection with the drainage catheter in place (white arrow). However, there is persistent regular thickening of the ileal loops where the fistulous tracts are located and reactive infiltration of the surrounding fat, with no detectable intra-luminal foreign body in the digestive tract. After brief resuscitation, the patient underwent emergency laparotomy. A textiloma was identified, causing dense adhesions and partial intraluminal migration into an ileal segment located 230 cm from the ligament of Treitz. A second intraluminal textiloma was palpated at the right colonic angle. Multiple intestinal perforations were noted: one in the ascending colon, one in the transverse colon, two in the sigmoid colon, and three in the rectum. Surgical management included resection of approximately one meter of small intestine with the creation of a double-barrel ileostomy, colorectal resection with a Bouilly-Wolkman double stoma, and colotomy for extraction of the second textiloma. Intra-abdominal drains were placed. Given the patient’s hemodynamic instability and septic shock requiring high-dose norepinephrine, primary anastomoses were deferred. Despite maximal supportive care, the patient died on the first postoperative day due to multiorgan failure. Discussion Gossypiboma is derived from the Latin word gossypium (meaning “cotton”) and the Swahili word boma (meaning “concealment”). 5 It is defined as a retained surgical sponge or gauze left in the patient’s body during a surgical procedure. These are most commonly found in the abdomen or pelvis. 6 This complication can affect any surgeon, regardless of experience. A recent report in gynecological departments showed that the mean age of the surgeon performing the procedure was 48 years (range: 35–59), while the mean age of the surgical nurse was 50.2 years (range: 43–56). The mean experience of the assisting nurse was 24.5 years (range: 6–36), and the mean age was 44 years (range: 30–55). 7 Due to the legal implications, retained surgical sponges are likely underreported, making it difficult to estimate their true incidence. 8 Moreover, their clinical presentation is often nonspecific or even absent. 9 In many cases, the complication is discovered incidentally during imaging studies, 8 or it presents with non-specific signs. The initial symptomatology’s inadequacy and the wide array of clinical presentations often hinder timely diagnosis. In fact, the time of declaration is often at a distance from the index operation, accounting for a median time of 12 months between the index procedure and diagnosis of retained sponges. 10 While computed tomography (CT) is the most accurate radiologic modality for diagnosis, with an accuracy rate of 81.8%, 11 , 12 radiological exploration may be inconclusive due to the pleomorphic radiological spectrum. 13 Differential diagnosis can be challenging and may include serious affections such as abscesses, tumors, hematomas, or ruptured hydatid cysts. 11 , 14 , 15 Characteristic imaging findings on ultrasound and CT—such as a fluid collection with internal wavy structures—can help confirm the diagnosis, 15 but not always present. Therefore, a high index of suspicion must be maintained, particularly in high-risk situations. A US based team recalled medical records associated with all claims or incident reports of a retained surgical objects. 16 They concluded that patients with retained foreign bodies were more likely than controls to have an emergency surgery (risk ratio, 8.8 [95% confidence interval, 2.4 to 31.9]), unplanned change in the operation (risk ratio, 4.1 [95%confidence interval, 1.4 to 12.4]), and body-mass index (risk ratio for each one-unit increment, 1.1 [95% confidence interval, 1.0 to 1.2]). 16 Another study found that associated factors with a significantly higher risk of retained foreign objects were the total number of major procedures performed [odds ratio 1.6; 95% confidence interval, 1.1-2.3; P = 0.008] and an incorrect count (odds ratio 16.2; 95% confidence interval, 1.3-197.8; P = 0.02). 17 Similarly, a multi-institutional study found that unexpected intraoperative events (OR: 6.97; 95% CI: 2.04–23.7; p = 0.002) and longer procedure duration (OR per hour: 1.41; 95% CI: 1.03–1.92; p = 0.032) were independent risk factors. 18 A detailed surgical history, including known risk factors, should always be communicated to the radiologist, as this can facilitate earlier diagnosis. Surgical intervention is required to remove the foreign body. However, spontaneous expulsion through the rectum 10 or external urethra 19 were described. What’s more, gossypibomas have a propensity toperforate adjacent viscera, 12 thus necessitating prompt extraction to avoid visceral damage. Effective strategies to prevent retained surgical bodies include systematic sponge and instrument counts before cavity and skin closure, consistent and open communication within the operating teamc utilization of electronic tracking systems such as barcode and radiofrequency identification (RFID) technology. 20 A recent systematic review, addressing 72 articles, conjecturedthat implementation of new technologies, such as RFID, has been shown to improve patient safety and reduce costs associated with retained soft items. Additionally, magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of recovery of metallic ones. 21 The implementation of these new procedures can decrease significantly the incidence of retained surgical objects as 80% of these occur with what staff believe is a correct count. 1 In 2021, American College of Surgeons emphasized that health care professionals bear ethical, legal, and moral responsibility to optimize patient outcomes. 22 Preventive measures could cut the incidence of retained objects by half, as near-miss events account for approximately 50% of cases. 23 Conclusion Diagnosing gossypiboma is often challenging, leading to delayed treatment. Increasing awareness is crucial for timely recognition. This complication results in additional costs, legal consequences, and emotional strain on the surgical team. Prevention is the most effective approach, primarily through systematic counting of surgical materials and use of metal markers to enable early and accurate detection. Declarations Ethics approval Not required. This work is a single case report, which is generally not considered “research” requiring formal review by an ethics committee. The case describes the clinical management of one patient without any experimental intervention or deviation from standard care. Consent for publication Written informed consent for publication of their clinical details and clinical images was obtained from the parent relative of the patient. Data availability statement Zenodo. CARE checklist textiloma , 10.5281/zenodo.16944366 . 24 The project contains the following underlying data: • CARE checklist for textiloma Data is available under the terms of the Creative Commons Zero v1.0 Universal (CC0). Acknowledgements None. References 1. Retained Foreign Body: Introduction.[cité 10 juill 2024]. Reference Source 2. Retained surgical sponges. Bulletin. sept 2019; 101 (6): 222–225. Publisher Full Text 3. Biswas RS, Ganguly S, Saha M, et al. : Gossypiboma and Surgeon- Current Medicolegal Aspect - A Review. Indian J. Surg. 1 août 2012; 74 : 318–322. PubMed Abstract | Publisher Full Text | Free Full Text 4. Rabie ME, Hosni MH, Al Safty A, et al. : Gossypiboma revisited: A never ending issue. Int. J. Surg. Case Rep. 1 janv 2016; 19 : 87–91. PubMed Abstract | Publisher Full Text | Free Full Text 5. Gossypiboma Definition & Meaning|YourDictionary.[cité 8 juill 2024]. Reference Source 6. Wallace SC: Retained Surgical Items: Events and Guidelines Revisited.2017; 14 : 1. 7. Modrzejewski A, Nowak T, Parafiniuk M, et al. : The analysis of retained surgical foreign bodies after gynecological and obstetric procedures. 8. McIntyre LK, Jurkovich GJ, Gunn MLD, et al. : Gossypiboma: Tales of Lost Sponges and Lessons Learned. Arch. Surg. 1 août 2010; 145 (8): 770–775. Publisher Full Text 9. Alemu BN, Tiruneh AG: Gossypiboma: A Case Series and Literature Review. Ethiop. J. Health Sci. janv 2020; 30 (1): 147–149. PubMed Abstract | Publisher Full Text 10. Bani-Hani KE, Gharaibeh KA, Yaghan RJ: Retained surgical sponges (gossypiboma). Asian J. Surg. avr 2005; 28 (2): 109–115. Publisher Full Text 11. Manzella A, Filho PB, Albuquerque E, et al. : Imaging of Gossypibomas: Pictorial Review. Am. J. Roentgenol. déc 2009; 193 (6_supplement): S94–S101. Publisher Full Text 12. Varlas VN, Bors RG, Mastalier B, et al. : Gossypiboma, the Hidden Enemy of an Emergency Cesarean Hysterectomy—Case Report and Review of the Literature. J. Clin. Med. janv 2023; 12 (16): 5353. PubMed Abstract | Publisher Full Text | Free Full Text 13. Tchaou M, Tchangai B, Dosseh DF, et al. : Abdominal Gossypibomas: Computed Tomography Scanner Findings of a Series of 15 Cases. Open J. Radiol. 12 févr 2020; 10 (1): 16–22. Publisher Full Text 14. Mosrati MA, Toumi O, Jabra S, et al. : Le textilome: aspects épidémiologiques, difficultés diagnostiques et implications médico-légales à propos de 5 cas. Revue Africaine de Chirurgie et Spécialités. 2014; 8 (1): 11–16. 15. Masson E. EM-Consulte: Aspects radiologiques des textilomes.[cité 10 juill 2024]. Reference Source 16. Gawande AA, Studdert DM, Orav EJ, et al. : Risk factors for retained instruments and sponges after surgery. N. Engl. J. Med. 16 janv 2003; 348 (3): 229–235. PubMed Abstract | Publisher Full Text 17. Lincourt AE, Harrell A, Cristiano J, et al. : Retained foreign bodies after surgery. J. Surg. Res. avr 2007; 138 (2): 170–174. Publisher Full Text 18. Stawicki SPA, Moffatt-Bruce SD, Ahmed HM, et al. : Retained Surgical Items: A Problem Yet to Be Solved. J. Am. Coll. Surg. 1 janv 2013; 216 (1): 15–22. PubMed Abstract | Publisher Full Text 19. Umunna J: GOSSYPIBOMA AND ITS IMPLICATIONS. J. West Afr. Coll. Surg. 2012; 2 (4): 95–105. PubMed Abstract 20. Zejnullahu VA, Bicaj BX, Zejnullahu VA, et al. : Retained Surgical Foreign Bodies after Surgery. Open Access Maced. J. Med. Sci. 5 janv 2017; 5 (1): 97–100. 21. Weprin S, Crocerossa F, Meyer D, et al. : Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf. Surg. 12 juill 2021; 15 (1): 24. PubMed Abstract | Publisher Full Text | Free Full Text 22. ACS: The Prevention of Unintentionally Retained Surgical Items After Surgery.[cité 10 juill 2024]. Reference Source 23. Cima RR, Kollengode A, Garnatz J, et al. : Incidence and Characteristics of Potential and Actual Retained Foreign Object Events in Surgical Patients. J. Am. Coll. Surg. 1 juill 2008; 207 (1): 80–87. PubMed Abstract | Publisher Full Text 24. Mseddi MA: CARE checklist textiloma. Zenodo. 2025. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 19 Sep 2025 ADD YOUR COMMENT Comment Author details Author details 1 General surgery “B” department, Rabta Hospital, Tunis, Tunis, Tunisia 2 Gastroenterology “B” Department, Rabta Hospital, Tunis, Tunis, Tunisia 3 Medical Imaging Department, Rabta Hospital, Tunis, Tunis, Tunisia 4 Emergency department, Rabta Hospital, Tunis, Tunis, Tunisia Rakia Siala Roles: Conceptualization, Supervision, Validation Mohamed Ali Mseddi Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Haythem Yacoub Roles: Resources, Supervision EYA AZOUZ Roles: Resources, Supervision Hajer Hassine Roles: Supervision Chaima Yacoubi Roles: Supervision Meriem Hsairi Roles: Supervision Fatma Trifa Roles: Supervision Radhia Boubaker Roles: Supervision Nesrine Krifa Roles: Supervision Sallemi Karim Roles: Supervision Emna Khemakhem Roles: Supervision Abdelwaheb Mghirbi Roles: Supervision Amal Bhira Roles: Supervision Yosra Yahia Roles: Supervision Souhir Mestiri Roles: Supervision Rami Guizani Roles: Supervision Brahim Ghariani Roles: Supervision Karim Sassi Roles: Supervision Hamida Maghraoui Roles: Supervision Hela Kchir Roles: Supervision Mohamed Ben Slima Roles: Supervision, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 04 Dec 2025, 14:947 https://doi.org/10.12688/f1000research.169895.2 version 1 Published: 19 Sep 2025, 14:947 https://doi.org/10.12688/f1000research.169895.1 Copyright © 2025 Siala R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Siala R, Mseddi MA, Yacoub H et al. Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.12688/f1000research.169895.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 19 Sep 2025 Views 0 Cite How to cite this report: Ishimaru T. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430364 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430364 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Nov 2025 Tetsuya Ishimaru , Pediatric Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.187284.r430364 This is a case report of a young woman who, unfortunately, died of an iatrogenic complication, gossypiboma. Sharing this tragedy and the insights learned from this case is necessary to prevent such a disaster from happening again. I appreciate ... Continue reading READ ALL This is a case report of a young woman who, unfortunately, died of an iatrogenic complication, gossypiboma. Sharing this tragedy and the insights learned from this case is necessary to prevent such a disaster from happening again. I appreciate the authors’ courage in revealing this case, but there are some concerns that need to be addressed. (Major) I agree that this article is not a study but a case report, and understand that the authors got approval for publication of the case from the bereavement. However, it seems better for the authors to inform the ethics committee at your institute about publishing this case in the journal to avoid any future possible conflicts, as the outcome of the case was unfortunate. (Minor) The images in Figures 3, 4, and 5 do not align with their explanations. Please correct them. In hindsight, can the author identify the artificial foreign bodies on the CT images performed on 11 days after drainage? It’s unclear when the last emergent contrast CT scan was performed. Please clarify it. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pediatric surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ishimaru T. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430364 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430364 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Saddique MN. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430359 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430359 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Nov 2025 Muhammad Nabeel Saddique , King Edward Medical University, Lahore, Pakistan Approved VIEWS 0 https://doi.org/10.5256/f1000research.187284.r430359 This case report describes a rare and severe presentation of intra-abdominal textiloma occurring 15 years after open ovarian cystectomy. The topic is clinically significant, as retained surgical items remain a preventable cause of morbidity, mortality, and medicolegal consequence. The ... Continue reading READ ALL This case report describes a rare and severe presentation of intra-abdominal textiloma occurring 15 years after open ovarian cystectomy. The topic is clinically significant, as retained surgical items remain a preventable cause of morbidity, mortality, and medicolegal consequence. The authors present a thorough narrative of the case, including imaging, operative details, and clinical outcome. The report adheres to CARE guidelines and provides visual documentation that enhances understanding. However, several aspects could be improved to strengthen clarity and impact. The clinical course should be presented in a clearer chronological sequence, ideally summarized in a short timeline or table. Imaging findings could be condensed to highlight key diagnostic clues and to clarify why the retained sponge was not suspected earlier. The discussion, while comprehensive, reads more as a literature summary than an analysis; it would benefit from emphasizing the unique aspects of this case—dual sponge migration, delayed presentation, and fatal postoperative course—and from expanding on system-level preventive strategies such as surgical count protocols, barcode or RFID tagging, and team communication. Language and phrasing should be refined for academic tone and fluency, as several expressions are informal. References should be standardized and updated with recent data on global incidence and safety measures. This is a valuable and instructive report on a critical patient safety issue. With minor revisions to structure, discussion depth, and language, it will make a meaningful contribution to surgical literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Meta-analyses, Systematic and Narrative Reviews, and Clinical Case Reports in the fields of Cardiology, Surgery, and Oncology, with an emphasis on evidence synthesis and clinical outcomes research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Saddique MN. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430359 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430359 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Tuma F. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r416483 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-416483 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Oct 2025 Faiz Tuma , Central Michigan University College of Medicine, Saginaw, Michigan, USA Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.187284.r416483 The article discusses interesting case but not uncommon. There are 22 authors for this case report. This is a very large number for a case report. The case is poorly written with numerous contextual mistakes. Here are some examples of ... Continue reading READ ALL The article discusses interesting case but not uncommon. There are 22 authors for this case report. This is a very large number for a case report. The case is poorly written with numerous contextual mistakes. Here are some examples of the mistakes and deficiencies: - "clinical examination revealed a patient with altered general condition (ECOG Performance Status = 2)" - No clear what that means. - "centered on a subparietal collection with additional blind-ending fistulae and a spiculated border" - Unclear. "On day 13" - what was the management during the 13 days? - "Proctological examination" - what does this exactly mean? - "It confirmed the progressive migration of both foreign bodies" – two FBs found? - "the other advancing to the rectosigmoid with distal externalization through the anal margin ( Figure 3 )" – not clear what that means. - "Figure 3. Images from the abdominal-pelvic CT scan performed 11 days after drainage: A- Axial CT scan after contrast injection at portal phase showing migration to the transverse colon of the intraluminal foreign body previously visualised at the caecal level (white arrow)" – it is not CT. It’s proctoscopy image. - "Figure 4. An endoscopic view of intra luminal textiloma, being externalized" – Not endoscopic view. Its specimen picture. - "Another study found that associated factors with a significantly higher risk of retained foreign objects were the total number of major procedures" - no clear what this means? - "such as RFID" – not clear what RFID is Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Surgical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tuma F. Reviewer Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r416483 ) The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-416483 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 19 Sep 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 04 Dec 25 read Version 1 19 Sep 25 read read read Faiz Tuma , Central Michigan University College of Medicine, Saginaw, USA Muhammad Nabeel Saddique , King Edward Medical University, Lahore, Pakistan Tetsuya Ishimaru , National Center for Child Health and Development, Setagaya, Japan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Ishimaru T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Jan 2026 | for Version 2 Tetsuya Ishimaru , Pediatric Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan 0 Views copyright © 2026 Ishimaru T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I’m truly sorry for the delay in my response to you. I appreciate that the authors addressed my previous comments seriously and am satisfied with the corrections. I identified two subtle issues that should be addressed. The second sentence of the 6th paragraph in the Discussion section, “toperforate” should be separated with a space. The first sentence of the 8th paragraph in the Discussion section, “conjecturedthat” should be separated with a space. Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatric surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ishimaru T. Peer Review Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.192324.r438580) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-947/v2#referee-response-438580 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ishimaru T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Nov 2025 | for Version 1 Tetsuya Ishimaru , Pediatric Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan 0 Views copyright © 2025 Ishimaru T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a case report of a young woman who, unfortunately, died of an iatrogenic complication, gossypiboma. Sharing this tragedy and the insights learned from this case is necessary to prevent such a disaster from happening again. I appreciate the authors’ courage in revealing this case, but there are some concerns that need to be addressed. (Major) I agree that this article is not a study but a case report, and understand that the authors got approval for publication of the case from the bereavement. However, it seems better for the authors to inform the ethics committee at your institute about publishing this case in the journal to avoid any future possible conflicts, as the outcome of the case was unfortunate. (Minor) The images in Figures 3, 4, and 5 do not align with their explanations. Please correct them. In hindsight, can the author identify the artificial foreign bodies on the CT images performed on 11 days after drainage? It’s unclear when the last emergent contrast CT scan was performed. Please clarify it. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatric surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Ishimaru T. Peer Review Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430364) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430364 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Saddique M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Nov 2025 | for Version 1 Muhammad Nabeel Saddique , King Edward Medical University, Lahore, Pakistan 0 Views copyright © 2025 Saddique M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report describes a rare and severe presentation of intra-abdominal textiloma occurring 15 years after open ovarian cystectomy. The topic is clinically significant, as retained surgical items remain a preventable cause of morbidity, mortality, and medicolegal consequence. The authors present a thorough narrative of the case, including imaging, operative details, and clinical outcome. The report adheres to CARE guidelines and provides visual documentation that enhances understanding. However, several aspects could be improved to strengthen clarity and impact. The clinical course should be presented in a clearer chronological sequence, ideally summarized in a short timeline or table. Imaging findings could be condensed to highlight key diagnostic clues and to clarify why the retained sponge was not suspected earlier. The discussion, while comprehensive, reads more as a literature summary than an analysis; it would benefit from emphasizing the unique aspects of this case—dual sponge migration, delayed presentation, and fatal postoperative course—and from expanding on system-level preventive strategies such as surgical count protocols, barcode or RFID tagging, and team communication. Language and phrasing should be refined for academic tone and fluency, as several expressions are informal. References should be standardized and updated with recent data on global incidence and safety measures. This is a valuable and instructive report on a critical patient safety issue. With minor revisions to structure, discussion depth, and language, it will make a meaningful contribution to surgical literature. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Meta-analyses, Systematic and Narrative Reviews, and Clinical Case Reports in the fields of Cardiology, Surgery, and Oncology, with an emphasis on evidence synthesis and clinical outcomes research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Saddique MN. Peer Review Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r430359) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-947/v1#referee-response-430359 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tuma F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Oct 2025 | for Version 1 Faiz Tuma , Central Michigan University College of Medicine, Saginaw, Michigan, USA 0 Views copyright © 2025 Tuma F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The article discusses interesting case but not uncommon. There are 22 authors for this case report. This is a very large number for a case report. The case is poorly written with numerous contextual mistakes. Here are some examples of the mistakes and deficiencies: - "clinical examination revealed a patient with altered general condition (ECOG Performance Status = 2)" - No clear what that means. - "centered on a subparietal collection with additional blind-ending fistulae and a spiculated border" - Unclear. "On day 13" - what was the management during the 13 days? - "Proctological examination" - what does this exactly mean? - "It confirmed the progressive migration of both foreign bodies" – two FBs found? - "the other advancing to the rectosigmoid with distal externalization through the anal margin ( Figure 3 )" – not clear what that means. - "Figure 3. Images from the abdominal-pelvic CT scan performed 11 days after drainage: A- Axial CT scan after contrast injection at portal phase showing migration to the transverse colon of the intraluminal foreign body previously visualised at the caecal level (white arrow)" – it is not CT. It’s proctoscopy image. - "Figure 4. An endoscopic view of intra luminal textiloma, being externalized" – Not endoscopic view. Its specimen picture. - "Another study found that associated factors with a significantly higher risk of retained foreign objects were the total number of major procedures" - no clear what this means? - "such as RFID" – not clear what RFID is Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Surgical Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Tuma F. Peer Review Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :947 ( https://doi.org/10.5256/f1000research.187284.r416483) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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