An Interesting Case of Vesical Gossypiboma Mimicking Calculus

BACKGROUND Gossypiboma is an iatrogenic mass lesion resulting from retention of a surgical sponge. Occurs 1 in 1000 - 1500 intra-abdominal operations. Most common retained foreign body is laparotomy sponge. The reports of this technical oversight are the tip of an iceberg due to medicolegal implications. We report a case of a retained surgical gauze presenting as a vesical calculus one year following open trans abdominal hysterectomy. CASE PRESENTATION A 32 years old female presented with history of dysuria, frequency, urgency, intermittency and suprapubic pain for the past 10 months. Patient gives history of trans abdominal hysterectomy for DUB one year back. Her previous operative notes revealed that there was a dense adhesion of the bladder to the uterine wall and during mobilisation the bladder was found to be injured, which was then repaired in two layers. On clinical examination, there was no abdominal mass and a healthy Pfannenstiel scar with suprapubic tenderness. Her urinalysis showed 6 to 8 pus cells. Urine culture showed no growth. Urine cytology was negative. Her X-ray KUB and USG KUB revealed a 4 cm vesical calculus. Diagnostic cystoscopy with Vesicolitholapaxy was planned. Cystoscopy revealed a single mobile vesical calculus (4 cm) with normal bladder mucosa .On proceeding with Vesicolitholapaxy, gauze was identified in the core of the calculus. We convert to open vesicolithotomy and retrieved the vesical calculus with gauze enmass. Postoperative period was uneventful. Urethral Foley catheter was removed on 7th postoperative day. On follow-up patient was symptom free. CONCLUSION Gossypiboma can be prevented. The use of small gauze swabs should be avoided at all cost. If they are used various measures according to guidelines should be followed. Vesical gossypiboma should be taken into consideration as a differential diagnosis in patients with persistent bladder symptoms and intravesical calcification following previous open urologic and gynecological surgeries.