Cardiovascular Journal of Africa: Vol 31 No 2 (March/April 2020)

63 / 68

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020 AFRICA e5
Case Report
A 31-year-old pericardial textiloma
Dong Kyu Kim, Su Kyung Hwang, Sang Cjeol Lee, Yong Jik Lee, Jong Pil Jung, Chang Ryul Park,
Gwan Sic Kim
Abstract
Gossypibomas are uncommon but important complica-
tions of surgery. This case report is of a gossypiboma found
accidentally 31 years after heart surgery. A 41-year-old man
had lost 5 kg in the previous three months and suffered from
intermittent epigastric discomfort. A computed tomography
scan incidentally revealed a well-defined mass in the right
lower anterior mediastinum. Given his history of previous
cardiac surgery to repair a ventricular septal defect, the possi-
bility of gossypiboma could not be excluded. Elective excision
of the mass was performed through a median sternotomy,
and a 5-cm ovoid mass consisting of a thrombus and gauze
was removed. The postoperative course was uneventful. The
patient’s clinical findings were normal, with no abnormal
findings on transthoracic echocardiogram performed one
year later.
Keywords: textiloma, gossypiboma, gauzoma
Submitted 15/9/19, accepted 28/10/19
Published online
Cardiovasc J Afr 2020; 31: e5–e8
DOI: 10.5830/CVJA-2019-068
Gossypibomas are rare but can cause serious medicolegal
issues after surgeries of the thorax, abdomen or pelvis. This
complication occurs due a counting error with regard to the
materials used during surgery and tends to be under-reported.
If an abnormal mass is found in a patient who has undergone
surgery, the possibility of a gossypiboma should be considered.
If diagnosed, surgical removal is the treatment. We report a case
of a 41-year-old man who presented with epigastric pain and
weight loss and was diagnosed with a gossypiboma caused by
heart surgery carried out 31 years before.
Case report
A 41-year-old man had lost 5 kg in the previous three months
and had suffered from intermittent epigastric discomfort. He
presented to the emergency roomwith pain in the upper abdomen
that began eight hours before his visit. He had undergone repair
of a ventricular septal defect 31 years earlier.
The initial vital signs, simple radiography, 12-lead
electrocardiogramand laboratory
abdominal computed tomography (CT) scan incidentally revealed
a well-defined mass in the right lower anterior mediastinum; no
other abdominal findings were found. Subsequently, a chest CT
scan showed a round, heterogeneous mass measuring 4.5 × 4
× 5 cm situated adjacent to the right atrium. A transthoracic
echocardiogram revealed a heterogeneous and echogenic mass
with a slight mass effect on the right atrium, and increased right
ventricular outflow tract velocity (peak velocity = 2.46 m/s). The
size of the left ventricle and systolic function were normal.
An elective operation to remove the mass was performed, to
eliminate compression of the right atrium and obtain accurate
histological findings. A median sternotomy was performed and
a 5-cm ovoid mass was observed, strongly adhered to the right
atrium and pericardium (Fig. 1A). The mass was not easy to
peel off and a right atrial injury occurred during the dissection
(Fig. 1B). It was necessary to resect and reconstruct part of
the right atrium to completely remove the mass. We started
cardiopulmonary bypass through the aorta, superior vena cava
and right femoral vein. The mass was completely removed
under cardiopulmonary bypass support. After removing the
mass, a 2 × 3-cm defect formed in the right atrium, which was
reconstructed using bovine pericardium (Fig. 2).
The cross-section of the mass indicated an old thrombus and
blood clots. We found that the thrombus and gauze were adherent
(Fig. 3). Specimens were sent to the Pathology Department for
diagnosis and formal histopathological examination confirmed
a textiloma. The patient’s postoperative course was uneventful
and the clinical findings were normal, with no abnormal findings
on transthoracic echocardiogram performed one year after the
operation.
Discussion
Gossypiboma, also known as a textiloma or gauzoma, refers
to a foreign body left in the body after a surgical procedure,
which becomes a mass. It usually consists of surgical gauze and
inflammatory tissue caused by the foreign body reaction.1
This disease poses medicolegal issues, so it tends to be
under-reported. The prevalence of this disease is about one
Department of Thoracic and Cardiovascular Surgery, Ulsan
University Hospital, Ulsan University Medical School,
Ulsan, Republic of Korea
Dong Kyu Kim, MD
Su Kyung Hwang, MD
Sang Cjeol Lee, MD
Yong Jik Lee, MD
Jong Pil Jung, MD
Chang Ryul Park, MD
Gwan Sic Kim, MD,