Gossypiboma of renal compartment: A case report

Abstract

Introduction: Textiloma is a rare surgical complication. The location in the renal compartment is exceptional. The diagnosis can be difficult due to its rarity and the absence of clinical signs. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure.

Presentation of case: We present a case report of a 71-year-old female patient with a high blood pressure under treatment. In this history, we noted a right nephrectomy by a lombotomy 6 years ago indicated for a mute kidney on a pyelo-ureteral junction syndrome and a drainage of a suppuration of this renal compartment a year after surgery. The patient was diagnosed with purulent discharge through the lombotomy site associated with lower back pain that had been present for 4 years. The patient then underwent an uro-CT scan which showed an oval formation of the right renal compartment suggestive of a textiloma. An exploratory right lombotomy was performed. And then the wetraction of the compresses followed by washing and closing had been done. The postoperative course was simple.

Discussion: The location in the renal compartment is exceptional. These may include compresses, surgical gauzes, sponges, cotton pads, etc. The inflammation caused by this foreign body will be responsible for an abscess in the event of infection. An evolution towards chronicity follows as long as the foreign body persists. Diagnosis and reoperation are often made during the same hospitalization period. Early imaging will help to make early diagnosis avoiding diagnostic wandering. The diagnosis was made late in our observation. However, the diagnosis can be difficult due to its rarity and the absence of clinical signs.

Conclusion: Textiloma is a rare surgical complication. Renal localization, although rare, is "exceptional" of consequence. The best treatment remains preventive by carefully counting the compresses and the operating fields at the beginning and end of the procedure.

Keywords: Gossypiboma; Renal compartment; Retained foreign body; Textiloma.

Fig. 1

Preoperative photograph showing skin breakout with central ulceration next to the lombotomy scar.

Fig. 2

(A) coronal section and (B) axial section of the uro CT scan showing an oval formation of the right renal compartment suggestive of a textiloma.

Fig. 3

Intraoperative photograph showing (A) the extraction of the first compress and (B) two compresses extracted from the right renal compartment.

Fig. 4

Postoperative photograph showing a complete healing.