Foreign Bodies Simulating Mesenchymal Tumors: Laparo-Endoscopic Resolution in Abdomen and Mediastinum

Abstract

Introduction:

Retained surgical foreign bodies are underreported due to legal concerns. They may remain asymptomatic or cause acute complications with nonspecific imaging findings, leading to delayed diagnosis. Awareness in previously operated patients is essential, and their impact has driven preventive measures such as standardized counts, detection technologies, and surgical checklists.

Case Presentation:

A 38-year-old woman with prior urologic and gynecological surgeries presented with 3 days of left flank pain, fever, nausea, and vomiting. Imaging revealed a large heterogeneous abdominal mass. Exploratory laparoscopy identified a cystic lesion with dense adhesions to the abdominal wall, small bowel, and sigmoid colon. Adhesiolysis exposed purulent material and a retained foreign body. The lesion and foreign body were removed, bowel defects were repaired, and the abdomen was irrigated. The postoperative course was uneventful, and the patient was discharged on day 6. The second case is a 68-year-old man with cardiovascular comorbidities and a remote history of pulmonary tuberculosis who was followed for an asymptomatic 6 cm anterior mediastinal mass. Due to suspected malignancy, thoracoscopic resection was performed. Intraoperatively, dense fibrosis was found, and conversion to a utility thoracotomy was required. Opening the mediastinal pleura revealed purulent material and a retained surgical gauze. Removal caused significant bleeding from vessel erosion, which was controlled with packing, vascular clamping, and suturing.

Discussion:

The cases demonstrate that retained surgical items are preventable “never events” with significant clinical, ethical, and legal consequences. They often present with nonspecific symptoms and delayed diagnosis, requiring reoperation. Despite standard precautions, human and procedural factors persist, emphasizing the need for improved surgical safety culture, advanced prevention strategies, and meticulous reintervention techniques.