Gossypiboma, a condition characterized by the inadvertent retention of surgical materials within a patient’s body after surgery, presents a challenging diagnostic scenario. This case report describes a 40-year-old woman who carried a retained surgical gauze unknowingly for seven years, highlighting the elusive nature of gossypiboma.

Following an emergency caesarean hysterectomy for postpartum haemorrhage in 2015, the patient developed postcoital bleeding, dyspareunia, and urinary symptoms. An initial MRI suggested the presence of chronic hematoma, which was managed conservatively. Seven years later, the symptoms recurred, prompting clinical examinations that raised suspicion of cervical carcinoma. Negative cervical biopsies, a repeat MRI and a CT scan indicated the possibility of gossypiboma, which was confirmed on cystoscopy. A laparotomy revealed a gauze in the pelvis, fistulizing into the bladder, that was successfully removed.

The reported incidence of gossypiboma varies considerably, with likely under-reporting due to legal concerns, making it a challenge to ascertain its true frequency. Diverse clinical presentations, masquerading as other medical conditions, lead to diagnostic complexity.

The cornerstone in addressing gossypiboma is prevention, emphasizing meticulous counting of surgical materials before and after surgery, using sponges or materials with radio-opaque markers, and thorough exploration of the surgical site before closure.