Despite being a well-described phenomenon in the surgical world, Gossypiboma is still a frequent problem in multiple countries. This could be partly because not all cases are presented with immediate post-surgical symptoms. Some patients presented after several years due to the delayed non-inflammatory reaction of the body to the retained gauze. Furthermore, although in our case x-rays showed abnormal signs indicating a possible bowel obstruction, regular abdomen X-ray usually doesn’t provide conclusive evidence of the underline existing gossypiboma. That is why CT- abdomen is considered the preferred choice in such cases.

The present study focuses on intestinal obstruction caused by gossypiboma and reported in African countries ten years ago. All cases are females. This may be because they are more exposed to surgical operations due to obstetric surgery.

Several reviews were reported regarding Gossypiboma, one of these reports was written by Wan et al., about retained surgical sponges, which were found in the abdomen in (56%) of the cases. It was commonly detected using computed tomography (61%) and radiography (35%). Furthermore, the median discovery time was of 2.2 years, all of which go in line with the characteristic of our case [8] [13].

Another review was done in Sudan by Suliman et al. and published in 2013, which reviewed several local cases of Gossypiboma in Sudanese females after cesarean section. Which presented with signs of infection and bowel obstruction and required surgical intervention to remove the retained surgical gauze. Luckily all the patients in this report survived until discharge from the hospital [9].

Likewise, Yorke et al. reported a case of intestinal obstruction due to an intraluminal foreign body. In this case, a patient underwent a laparotomy to treat ruptured acute appendicitis. A laparotomy towel was left behind during the operation [10]. In addition, as reported by Emegoakor et al. in Nigeria in 2021 a 28-year-old woman, following an open myomectomy in a private hospital, suffered from colicky abdominal pain, distention, and a mass for 9 months [11]. both patients in this study had similar complications of intestinal obstruction which was the same fate of our patient.

A similar course of events was noticed in the post-myomectomy case reported by Naiem et al. in 2021 which presented with acute abdominal signs after almost 6 months of the primary operation and it was then discovered to be due to infected missed surgical gauze that was then extracted with good patient outcome [12].

For such cases and once the diagnosis has been made, management includes investigations, parenteral antibiotics, intravenous fluids, and emergency laparotomies. In addition, laparoscopic retrieval may also be carried out if the diagnosis is done early [13, 14].

Medical practitioners, especially surgical staff, must be aware of the risk factors that cause retained sponges and take deliberate steps to avoid them [2, 15, 16]. This could involve Keeping a detailed pack and instrument count at the beginning and the end of the surgery, performing a thorough methodical wound examination and abdominal exploration before closure and performing intraoperative radiologic screening or re-exploration when there is a doubt about the accuracy of the final count [17]. A high suspicion index is needed to diagnose gossypiboma and implement prompt interventions to reduce patient morbidity and mortality [16].

One of the promising solutions to decrease the rate of Gossypiboma is the use of tagged surgical gauze which can be detected by regular x-ray. This is expected to decrease the rate of error associated with the use of manual counting (Table 1).