Delayed omental textiloma mimicking an intra-abdominal tumor with a concurrent ulcerative abdominal wall lesion: a case report

Introduction: Retained surgical gauze (textiloma or gossypiboma) can remain asymptomatic for many years and may eventually present as an abdominal mass indistinguishable from a tumor on imaging, while concomitant inflammatory skin lesions, such as suspected pyoderma gangrenosum (PG), may further confound the diagnosis. Case presentation: A 47-year-old woman with five prior cesarean deliveries and an elective umbilical herniorrhaphy 12 years earlier presented with a progressively enlarging infra-umbilical ulcer and a prior history of rash and blistering, along with worsening constipation, followed by rectal bleeding due to a coincidental anal fissure. A contrast-enhanced CT scan revealed a 6.5 × 7.0 × 4.0 cm enhancing omental mass that lacked spongiform or calcification features; the imaging was suggestive of a gastrointestinal stromal tumor or a desmoid tumor. During laparoscopy, which was converted to laparotomy due to dense adhesions, an encapsulated omental mass was completely resected; histopathology demonstrated a textiloma and ruled out malignancy. The abdominal wall ulcer remained clinically suspicious for PG; however, the patient refused a biopsy during follow-up. Conclusion: Textiloma should remain in the differential diagnosis for an unexplained omental mass after prior abdominal surgery, even in the absence of classic imaging features, and PG should not be diagnosed without histopathological confirmation.