Chronic Foreign Body Inflammatory Response in Textiloma Formation: Case Report and Analysis of Current Evidence

A gossypiboma (GPB), also referred to as a textiloma (TXT), is a mass formed as a result of the body's inflammatory and granulomatous response to retained surgical textile material (RSTM), most commonly gauze or mesh fibers. Its reported incidence ranges from 1 in 1,000 to 1 in 10,000 surgical procedures, although the true frequency is believed to be significantly higher due to underreporting related to medicolegal concerns. This entity is clinically important because it may mimic more common postoperative complications such as abscess (ABS), seroma (SER), or mesh infection (MI), frequently leading to diagnostic delay and unnecessary morbidity. The purpose of this report is to present an uncommon instance of mesh-associated textiloma (MAT) following ventral hernia repair with polypropylene mesh (PPM) and to highlight its radiologic, histopathologic, and clinical features that allow differentiation from other postoperative collections. A 39-year-old female patient with a history of ventral hernia underwent surgical repair with mesh implantation. Postoperatively, she developed persistent umbilical discharge and, three months later, progressive abdominal fluid leakage. Contrast-enhanced computed tomography (CECT) revealed a well-defined hypodense intraperitoneal collection measuring 80 × 64 × 40 mm with a fistulous tract (FT) extending to the abdominal wall, without evidence of systemic inflammatory dissemination. These features, particularly the encapsulated nature of the collection and the organized fistulization pattern, were highly suggestive of a chronic foreign-body reaction (FBR) rather than an acute ABS, which typically presents with diffuse inflammatory infiltration, or MI, which is associated with diffuse mesh thickening and surrounding cellulitis. A second surgical exploration was performed, and the resected specimen underwent histopathological examination (HPE), which demonstrated foreign-body granulomatous inflammation (FBGI) with multinucleated giant cells (MGC) surrounding textile fibers embedded in fibrous tissue, consistent with MAT, and without evidence of dysplasia or malignancy. Following complete excision and aponeurotic closure, the patient recovered uneventfully, with no recurrence during follow-up. This case reinforces that MAT should be included in the differential diagnosis of persistent postoperative collections after mesh-based hernia repair and demonstrates that characteristic CECT findings combined with timely surgical management are essential to reduce morbidity and prevent long-term complications.