Textiloma: surgical and forensic implications of medical negligence. A case report and literature review

A textiloma or gossypiboma is a rare but serious iatrogenic complication, caused by the retention of surgical sponges or gauze within the body after surgery. Often underreported, it may remain undetected for years, leading to diagnostic challenges with significant clinical and medicolegal implications. Our study reviewed the clinical and legal aspects of textilomas. We conducted a review by searching the terms "textiloma" and "post-surgery" in a single database (PubMed) from 2014 to 2024. After excluding non-iatrogenic cases and article with no forensic or surgical interest, 25 relevant articles were found and analyzed. Clinical presentation of textilomas is variable, depending on the surgical site. Seventy percent of cases occurred after abdominal surgery, with all patients requiring further surgeries. In some cases, the foreign body migrated to other organs, and diagnosis was often delayed due to the ability of textilomas to mimic tumors, complicating differential diagnoses. Medicolegal consequences are significant: healthcare professionals may face criminal charges for negligence, even years after the index surgery. In cases of multiple surgeries, identification of the origin of the retained foreign body can be challenging, though modern tissue tracing methods may assist in identifying hospital sources. Professionally, physicians can be held liable for personal injury or patient death, leading to career damage and malpractice claims. Given that textilomas occurrence is a preventable event, they pose not only a professional and legal concern but also a public health issue, emphasizing the importance of effective prevention and risk management strategies.