Textiloma mimicking retroperitoneal sarcomatoid carcinoma: A case study of diagnostic and therapeutic challenges.

ABSTRACT

INTRODUCTION: textilomas, caused by forgotten surgical sponges, triggers inflammatory reactions, leading to complications like abscesses and fistulas. Often asymptomatic or presenting as an abdominal mass, they pose diagnostic challenges. This case study reports a textiloma mimicking a retroperitoneal sacromatoid carcinoma, discovered post-tumorectomy, and explores related diagnostic and therapeutic issues. CASE REPORT A 58-year-old woman with a history of ureterolithotomy presented with chronic lumbar pain, fever, and a right retroperitoneal mass. Clinical and biological examinations indicated an inflammatory syndrome. CT and MRI imaging revealed a well-defined cystic mass, suspected to be a sarcomatous tumor. Surgical removal of the mass followed oncological principles. Histopathological examination confirmed it was a textiloma, a reaction to a forgotten surgical sponge, with no malignancy. DISCUSSION: a textiloma, or gossypiboma, is a rare postoperative complication caused by forgotten surgical sponges, is common in intraperitoneal and gynecological regions, it is rare retroperitoneally. Textilomas provoke acute inflammatory reactions leading to abscesses or chronic inflammation causing fibrosis and calcifications. Diagnosis is challenging due to non-specific clinical signs, often requiring radiological investigations. CT and MRI can reveal characteristic features like serpiginous centers and spongiform appearances. Surgical removal is necessary. Recovery is usually uncomplicated in 60 % of cases, though severe complications and deaths can occur in delayed interventions. CONCLUSION: The medical history and imaging are crucial for diagnosing textilomas, whose incidence has decreased with radio-opaque marked sponges. Despite this, meticulous sponge counting remains essential but insufficient to completely eliminate the risk.