A 30-Year-Old Asymptomatic Gossypiboma Following Dorsolumbar Scoliosis Surgery: A Rare Case and Literature Review

Background: This study aims to highlight the deceptive radio-clinical presentation, chronic progression, and atypical localization of a textiloma involving the iliac wing. Case Presentation: A 46-year-old female patient, with a history of thoracolumbar scoliosis surgery at the age of 16 (in 1993), presented with a painless swelling in the inferomedial quadrant of the left gluteal region, progressively increasing in size over the past three years. Ultrasound examination revealed a well-circumscribed, oval, hypoechoic subcutaneous mass in the left gluteal region, measuring 4 cm in its longest dimension. MRI identified two distinct soft tissue masses in the left gluteal region: the first adjacent to the iliac and gluteus minimus muscles, encapsulated, and measuring 50 mm, the second located in the subcutaneous tissue, also well-demarcated, measuring 40 mm. Results: Surgical excision biopsy was performed. Intraoperatively, a firm well-encapsulated subcutaneous fatty mass was found, clearly separated from the gluteus maximus fascia, with no signs of infection. Histopathological analysis confirmed an intermediate-grade soft tissue leiomyosarcoma measuring 7 cm, with clear resection margins. A thoraco-abdomino-pelvic CT scan showed no evidence of secondary lesions but revealed a lytic lesion of the left iliac wing, raising suspicion of a malignant process. Surgical biopsy of the iliac wing lesion revealed a textiloma at the donor site of the cancellous bone graft harvested during spinal surgery performed three decades earlier. No signs of infection were observed. Discussion and Conclusions: Despite its rarity, textiloma should be considered in the differential diagnosis of any mass lesion in patients with a history of prior surgery. Prevention remains paramount and relies entirely on meticulous surgical protocols, including accurate sponge and instrument counts before and after each procedure.