A case of gossypiboma mimicking intrahepatic cholangiocarcinoma

Intrahepatic Gossypiboma as a Complication of Cholecystectomy: A Case Report

We present the case of a 75-year-old woman with a history of laparoscopic cholecystectomy, which was converted to an open procedure due to intraoperative hemorrhage. Two weeks later, she underwent reintervention to address a subhepatic hematoma. Over a follow-up period of 19 months, she remained symptomatic, experiencing persistent purulent discharge from the surgical drain site, mild fever, and abdominal pain. A CT scan revealed a gossypiboma, and following a failed surgical exploration, the patient was referred to a specialized center. A fourth surgical exploration identified an abscess in the abdominal wall and multiple abscesses within the liver, one of which contained an intrahepatic gossypiboma. Postoperative care involved a levofloxacin-based antibiotic regimen, leading to a favorable clinical outcome. This case represents an instance of a gossypiboma becoming fully internalized within the hepatic parenchyma following non-traumatic surgery.

Granulomatous liver diseases

A granuloma is a discrete collection of activated macrophages and other inflammatory cells. Hepatic granulomas can be a manifestation of localized liver disease or be a part of a systemic process, usually infectious or autoimmune. A liver biopsy is required for the detection and evaluation of granulomatous liver diseases. The prevalence of granulomas on liver biopsy varies from 1% to 15%. They may be an incidental finding in an asymptomatic individual, or they may represent granulomatous hepatitis with potential to progress to liver failure, or in chronic disease, to cirrhosis. This review focuses on pathogenesis, histological features of granulomatous liver diseases, and most common etiologies, knowledge that is essential for timely diagnosis and intervention.

Unusual Cause of Recurrent Cholangitis: Gossypiboma

Gossypiboma refers to a retained surgical sponge that can occur after any type of surgery. Though it is a rare complication of surgery, the retention of surgical sponges still occurs. We report a case of a 70-year-old woman who presented with recurrent upper abdominal pain and fever. She had a prior history of cholecystectomy and choledochoduodenostomy. Magnetic resonance cholangiopancreatography showed a filling defect in common bile duct. However, during endoscopic retrograde cholangiopancreatography and common bile duct clearance, clumps of woven fibres were removed suggestive of gossypiboma. 

Laparoscopic Removal of Gossypiboma

Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery.