The gossypibomas are the most frequently forgotten foreign bodies after surgery [4-8]. Their frequency is estimated to be between 1/1000 and 1/5000 on the abdominal surgeries . This incidence was one case on 3550 abdomino-pelvic surgeries at the Teaching University Hospital of Lomé.
Women were the most represented (11/15 cases).This is what is commonly reported [10, 11]. This female predominance could be explained by the type of incision performed during gynecological intervention that constituted the main initial surgeries .Actually, the suprapubic way, firstly transversal, frequently used during these procedures does not expose the entire abdominal cavity to be visible, thereby increasing the risk of textiloma. The emergency surgeries appear to be the most common cause of this type of post-operative incident [7, 8], the emergencies have accounted for 6/15 cases in this study.
The choice of imaging technique is based on the clinical signs. Immediately after the surgery, a simple unprepared X-ray of the abdomen is enough when the compresses used are marked; this is the most commonly used means of detecting gossypibomas . In our studies, 12/15 compresses did not have radiopaque markings, which is a major flaw in the safety of the surgical procedures. The use of labelled compresses, like the textile count, is part of measures to limit gossypibomas and their consequences [14, 15].The clinical expression is sometimes late and frustrating. As a result, the hypothesis of gossypiboma is not always raised by the clinician, who may request at first, examinations different from radiography. The Ultrasound, which is easy to access, can be performed, but this technique may fail with the presence of abdominal gases .
The computed tomography is the most effective test to diagnose the gossypiboma and its complications [10, 17]. In practice, it is firstly carried out for a clinical suspicion other than a gossypiboma, or in the second position after other techniques has failed. In fact, the computed tomography scan enables to raise the diagnosis when there is no radiopaque marking and the ultrasound has failed.
Different aspects can be noticed. The main aspect is related to the marking of the textile. This is typically a high density linear image with no differential diagnosis problems which could have been found on the abdomen X-ray performed without preparation or even the scout-view.
The other aspects can be individualized into 3 types which we have correlated with the type of foreign body reaction.
On the anatomopathological level, two forms of textilomas have been described corresponding to two types of reactions resulting from the presence of textiloma in an individual’s body. This will be either an exudative inflammatory reaction with an abscess or an aseptic reaction with fibrotic cotton reaction with mass development .
These anatomopathological aspects can be assimilated to the aspects on the scanner. The granomas correspond to spongy and pseudo cystic forms, late revelation which can even simulate an abdominal tumor [10, 16, 17].The forms with exudative inflammatory reactions correspond to the mixed forms in the scanner expressing abscesses and peritonitis, usually appearing within a short time after the first surgery.
The computed tomography can also be used to diagnose the complications of textiloma. The most common is the migration into a hollow organ. It occurs most often in the digestive tract, but also in the bladder, as we noticed in one of our patients, or in the genital tract [1, 19-23]. In the majority of cases it is a surgical surprise, the pre-operative diagnosis is for a fecaloma or tumor [16, 22, 24]. The diagnosis can be rectified if the history of surgery is specified to the radiologist.