Thigh textiloma: a case report of a rare iatrogenic mass following orthopedic surgery

Introduction and importance: Textiloma refers to a mass lesion caused by the iatrogenic retention of surgical gauze. Although well described in abdominal and thoracic surgery, its occurrence following musculoskeletal interventions remains rare and underreported. Case presentation: We report the case of a sexagenarian man presenting with swelling of the left thigh, associated with pain. His medical history was notable for a left femoral neck fracture treated 12 years earlier with locked intramedullary nailing. While hematological and biochemical tests showed no abnormalities, plain radiography and MRI suggested either chronic osteomyelitis with fistulization or a tumor, particularly a sarcoma. Given the diagnostic uncertainty, the therapeutic decision was to perform excision of the collection with debridement and lavage, followed by postoperative antibiotic therapy. The bacteriological analysis returned negative, while the pathological examination revealed a foreign body (gauze) that polarized under polarized light. These findings were consistent with a textiloma. The postoperative course was favorable, with good clinical and biological recovery and no subsequent complications. Clinical discussion: Textiloma is an iatrogenic retained surgical material that can trigger either an early exudative reaction or a delayed response mimicking tumors. Reported cases of thigh textilomas show variable latency periods and often present as masses with misleading imaging findings. Although rare, they may cause diagnostic confusion, recurrence, or even raise concerns about malignant transformation, highlighting the need for preventive measures and awareness. Conclusion: Textiloma should systematically be considered in the differential diagnosis of any postoperative mass. Increased awareness of this entity is essential to avoid misdiagnosis and prevent avoidable morbidity.