Textiloma: a case of foreign body mimicking a spinal mass

Abstract

Items such as cotton or gauze pads can be mistakenly left behind during operations. Such foreign materials (called textilomas or gossypibomas) cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. Some textilomas cause infection or abscess formation in the early stage, whereas others remain clinically silent for many years. Here, we describe a case of textiloma in which the patient presented with low-back pain 4 years after lumbar discectomy. Imaging revealed an abcess-like mass in the lumbar epidural space.

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

“…The mechanism for infection at the surgical site is based on the fact that the retained sponge acts as an incubation plate and leads to a superinfection, which in turn results in fistulisation. Septic collection in exudative forms and abscesses has been attributed to early superinfections (2,12,15). All of our cases were diagnosed late, and none presented with exudative reactions.…”

“…Foreign bodies and peripheral inflammation may grow significantly and thus reveal new clinical evidence through mass development (2,12,15). The three cases presented herein were of this second form.…”

“…Although in the exudative form, acute phase reactants such as C-reactive protein, sedimentation, and leukocytosis are observed, laboratory tests may reveal normal results in the aseptic fibrinous form of textilomas. In patients with infections, often no growth is observed in the wound culture, which is usually associated with Staphylococcus strains (2,9,14). In the medical history of all cases that were referred to our clinic, there were no clinical and laboratory signs of infection in the primary centre where they had their first surgical interventions, so no microbiological tests were performed.…”

Textiloma formation post endovascular repair of abdominal aortic aneurysm

“…Such risk factors apply more frequently to intra-abdominal surgeries, and that explains the high incidence of these masslesions in the abdominal cavity. Less commonly than intra-abdominally, such lesions reside in the pelvis [8] and thorax [2], while there are few reported cases of a more rare presentation in the central nervous system, breast, and lower extremity [3][4][5]. To the best of our knowledge, there is no described case of an inguinal textiloma after a bifemoral accessed endovascular procedure.…”

“…They are most commonly intra-abdominally found; however, plenty of cases of textilomas are found to be located also in the thoracic area [2], in the thigh [3], the central nervous system [4], and the breast [5]. In the absence of highclinical suspicion, the diagnosis is challenging, as clinical symptoms may be nonspecific and imaging fi ndings are often inconclusive.…”