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gossypium ,  which means  cotton  and  boma  in kiswahili , which means  place of concealment  .
most often found in abdominal and pelvic cavities , retained gauze can cause a large variety of symptoms , including pain , palpable mass , fever , constipation , ileus , and fistulas ( wan et al . , 2009 ) .
two usual responses to retained surgical gauze are exudative reaction leading to abscess formation or fluid collection , and an aseptic fibrinous reaction resulting in adhesion , encapsulation , and eventual formation of granulomas of various sizes ( wan et al . , 2004 ) .
the time of presentation may range from early post - operative period to several decades later .
a correct diagnosis is difficult and can be made in only one - third of cases .
plain abdominal radiography , ultrasonography ( usg ) , computed tomography ( ct ) scan and magnetic resonance imaging ( mri ) are the diagnostic modalities available ( jason et al . , 1979 ; mochizuki et al . , 1992 ;
a minimally invasive technique such as laparoscopy is a good diagnostic and therapeutic modality in cases without a definitive preoperative diagnosis .
we report a case of retained surgical gauze diagnosed and removed by laparoscopic surgery , 24 yr after the cesarean delivery .
38-year - old athlete female patient admitted for a suspected pelvic mass , found on abdominal ct that was conducted during evaluation of lower quadrant ( rlq ) pain .
her abdominal was not painful , and nearly fist - sized hard mass was palpitated on right side of uterus .
ultrasonography revealed suspicious pelvic mass sized about 8 cm and it looked like subserosal myoma or right ovarian fibroma .
after admission plain abdominal radiography was performed , and irregular calcification suggesting tab - gauze in pelvis was found ( fig .
1 ) . contrast enhanced abdominal computerized tomography was also revealed that 9 cm sized mass lesion with irregular calcifications was seen at the anterior aspect to the uterus .
the pelvic mass was looked like tab - gauze and conglomerated with omentum , uterus and bladder ( fig .
dissecting the mass was very careful , but because of severe adherence , bladder wall was lacerated about 1 cm .
a foley cathter was inserted during an admission period and the patient was discharged on 7th postoperative day keeping foley cathter .
retained surgical sponge occurs at a frequency of one per 1003,000 operations ( kaiser et al . , 1996 ) .
radiologic investigations like usg , ct , and mri can give a fair estimate of the diagnosis .
but ambiguous clinical presentation in which a definite diagnosis is not available , laparoscopic intervention provides a diagnosis as well as simultaneous treatment . for this reason in these rare cases
the presence of a foreign body inside the patient is an avoidable problem and the patient may litigate the responsible surgeon . moreover , gossypiboma may be misdiagnosed as a malignant tumor and lead to unnecessary invasive diagnostic procedures or extensive extirpative surgery which may result in further complications ( zbar et al . , 1998 ) .
all surgical textile materials and instruments should be counted once at the start and twice at the conclusion of surgical procedures .
it has been reported that most cases of gossypiboma occur in presence of normal pack counts ( rappaport and haynes , 1990 ) .
hurried counts that may occur in emergency operations or an unexpected change in procedure might also contribute to increase the incidence of gossypiboma .
when there are changes in theater personnel , the mistake is more likely . high body mass index of patients has been given as another risk factor ( gawande et al .
on the other hand , when the accuracy of final count is in doubt , intraoperative radiologic screening may detect any retained surgical textile material impregnated with a radio - opaque marker . moreover , gawande et al .
( 2003 ) suggested the routine radiographic screening of high - risk patients before they leave the operating room even when counts are documented as correct . at the time of any operation
, the operation field should be thoroughly examined for retained surgical textile materials and instruments , particularly where packs have been employed remotely from the site of main surgery .
even though the surgeon carries the major responsibility , this problem can only be overcome if all the members in an operation team work together meticulously as concluded by schelhaas and mastboom ( 2002 ) .
retained surgical gauze that was left inside the patient during a surgical procedure is called gossypiboma or textiloma . it is a rare complication of surgery commonly seen after abdominal operations . 
 the symptoms of gossypiboma are non - specific , such as pain , palpable mass and fever , which make clinical diagnosis difficult . 
 we present a case of young female athlete patient with right lower quadrant ( rlq ) pain for 1 month , caused by surgical gauze which was retained from previous cesarean delivery performed 24 yr ago . 
 patient with retained surgical gauze can be asymptomatic for a long period . in our case , 
 laparoscopy was used as the diagnostic and therapeutic tool . 
 this report discusses the approach to , and manifestations of gossypiboma which presents a long asymptomatic period .