LARGE PELVIC GOSSYPIBOMA DIAGNOSED AT THE TIME OF RADICAL PROSTATECTOMY 30 YEARS AFTER INGUINAL HERNIOPLASTY

Case Report: A 71-year-old man was referred to our centre for obstructive lower urinary tract symptoms (LUTS) and history of a vague, chronic discomfort in the right groin and testis since many years. Prostate-specific antigen (PSA) level was 12 ng/dl. The diagnostic work up revealed a Gleason score 4+4=8 adenocarcinoma of the prostate. No bone metastases were present. At the preoperative computed tomography (CT) scan, there was no evidence of pathologic pelvic lymph nodes on the left side of the pelvis, while a 3.0×5.0 cm solid mass of unknown nature was found close to the right iliac vessels (Figure 1). The central area was dishomogeneous as due to necrotic tissue; in turn, the peripheral, hypodense crown contained several hyperdense spots. The densitometric aspect of the prostate was highly irregular. The patient was then scheduled for open radical prostatectomy and extended pelvic lymph node dissection (ePLND). During the right lymph node dissection, a solid mass, firmly adherent to the right iliac vessels, was carefully isolated and removed intact. The intraoperative examination revealed a retained surgical sponge with a peripheral fibrous pseudocapsule resulting from an inflammatory foreign-body reaction, known in literature as gossypiboma or textiloma (Figure 2) (1).Indeed, the patient underwent emergency surgery for incarcerated inguinal hernia 30 years before. Discussion and Conclusion: Although more infrequent with standardized surgical counting (2), gossypibomas can still be either asymptomatic occasional findings or, if not promptly diagnosed, life threatening causes of intestinal obstruction and acute abdomen. Moreover, they can simulate intra-abdominal gastrointestinal stromal tumors making the differential diagnosis challenging. The problem of retained surgical items affects both open and minimally invasive surgery (3). Prevention is a key aspect to ensure the maximal safety of surgical patients.