Case Report: Bezoar-mimicking intraluminal gossypiboma causing small-bowel obstruction and chronic malabsorption 15 years after hysterectomy.

BACKGROUND: Gossypiboma (textiloma) denotes a retained surgical textile enclosed by a foreign-body reaction. It may remain silent for years or present with nonspecific symptoms; transmural migration into the bowel lumen is a rare complication that can cause obstruction or malabsorption and is frequently mistaken for other intraluminal masses. CASE PRESENTATION: A 65-year-old woman with a total abdominal hysterectomy for uterine myomatosis 15 years earlier presented with 15 days of right-upper-quadrant pain and gastrobiliary vomiting, superimposed on 3 years of intermittent chronic diarrhea and a 15-kg weight loss in the preceding year. She was hypotensive and dehydrated, with hyponatremia and acute kidney injury. Unenhanced multiplanar abdominopelvic CT, intravenous contrast having been withheld because of the acute kidney injury and enteral contrast because of vomiting and obstruction, showed an intraluminal right-flank mass with a mottled, spongiform pattern containing gas, mural thickening with mesenteric fat stranding and laminar free fluid, a transition point with proximal small-bowel dilatation and air-fluid levels, and retrograde dilatation of the proximal loops. No radio-opaque marker was identified, and the mass was initially interpreted as a bezoar. Because she was managed emergently, no dedicated malabsorption workup was performed, and the malabsorptive syndrome remained a clinical diagnosis. At emergency laparotomy, a paracecal internal hernia and a bezoar-like intraluminal mass 30 cm from the ileocecal valve were found; en bloc resection of the affected ileum and sigmoid colon with a diverting ileostomy and mucous fistula was performed. Histopathology confirmed a 30-cm surgical gauze. She recovered uneventfully and was discharged on postoperative day 5. CONCLUSION: Intraluminal gossypiboma should be considered in any patient with previous abdominal or pelvic surgery who presents with chronic refractory diarrhea, malabsorption, or unexplained bowel obstruction, even decades later. CT is the modality of choice, although its diagnostic yield falls when intravenous contrast cannot be administered and no radio-opaque marker is visible, as occurred here; definitive management is surgical removal. Follow-up was limited to the early postoperative period; stoma reversal and confirmation of resolution of the malabsorptive syndrome remain pending. Rigorous surgical counts and radio-opaque-marked textiles remain the cornerstone of prevention.