Background: The retention of gauze swabs in the peritoneal cavity is an infrequent but avoidable medical error. It can lead to serious morbidity and even mortality because it is not anticipated and is frequently misdiagnosed. Case: A 45-year-old woman presented 8 years after hysterectomy with pain in her abdomen. There was an 8 × 8-cm cystic mass palpable in the right iliac fossa that was tender. The mass was not felt on bimanual pelvic examination or on per rectal examination. Ultrasonograhy and computed tomography scan findings were suggestive of ovarian/mesenteric cyst. Laparotomy revealed a gossypiboma in the omentum. Conclusions: Gossypiboma can present a long time after previous surgery and can mimic ovarian cyst clinically. It has serious medicolegal and surgical consequences, and preventive measures to minimize this should be strictly followed. (J GYNECOL SURG 27:33)
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