Asian Journal of Research in Surgery

Aims: Textiloma (gossypiboma) denotes the inadvertent retention of a surgical sponge or gauze within a body cavity following an operation. It is a rare but clinically significant entity with protean manifestations and serious medicolegal implications. We report an exceptional case of a giant left hepatic textiloma that presented 26 years after hepatic hydatid cyst surgery and radiologically mimicked hydatid cyst recurrence.

Presentation of Case: A 51-year-old woman with a history of midline laparotomy for hepatic hydatid cyst disease in 1999 presented with a 21-day history of progressive epigastric heaviness, pain, and vomiting. Computed tomography (CT) revealed a large anterior left paramedian abdominal mass measuring 22.8 × 13.7 × 18.5 cm, with extensive internal necrosis, coarse calcifications, and perilesional lymphadenopathy—features overlapping with hydatid cyst recurrence and malignancy. Surgical exploration demonstrated a densely encapsulated mass firmly adherent to the left hepatic lobe and mesenteric structures. Complete excision was performed. Gross examination and histopathological analysis confirmed a chronic foreign body granulomatous reaction encapsulating degraded surgical textile material retained from the 1999 procedure.

Discussion: Encapsulated textiloma may remain clinically silent for decades before becoming symptomatic. In hydatid-endemic regions, its CT features—peripheral calcification, internal heterogeneity, and a complex cystic/solid mass—closely mimic those of recurrent hydatid disease, creating a genuine diagnostic pitfall. Awareness of this overlap and meticulous review of the surgical history are critical to avoiding misdiagnosis.

Conclusion: Textiloma must be included in the differential diagnosis of any abdominal mass following prior surgery, especially in hydatid-endemic regions. Complete surgical excision is the definitive treatment. Prevention through rigorous intraoperative sponge-count protocols and the use of radiopaque-tagged sponges remains paramount.