29/04/2026
A “simple post-op scan” can quietly become a life-saving diagnosis… if you know what to look for.
Yesterday, I reviewed a post–caesarean section patient with severe abdominal pain, foul vaginal discharge, and systemic weakness just days after surgery.
On ultrasound, the findings were not “routine post-op changes.”
They were loud.
• Complex intra-abdominal fluid collections
• Inflamed echogenic fat planes (fat stranding)
• Bowel wall thickening with reactive ileus
• Septated pelvic fluid
• And most strikingly… a well-defined echogenic avascular intra-cavitary mass
Then came the question every sonographer must learn to ask carefully:
Could this be a retained surgical material?
Enter: GOSSYPIBOMA
A gossypiboma is a retained surgical sponge or gauze left inside the body after surgery.
It is rare… but devastating when missed.
It can mimic:
• Abscess
• Hematoma
• Tumour
• Retained products of conception
• Intrauterine clot
And on ultrasound, it may present as:
• Echogenic mass with internal wavy echoes
• Posterior acoustic shadowing or dirty shadowing
• Avascular lesion on Doppler
• Surrounding inflammatory reaction or abscess formation
Why it matters
Because this is not just an imaging curiosity.
It is a preventable surgical complication that can lead to:
• Sepsis
• Peritonitis
• Fistula formation
• Chronic pain
• Repeat surgery
• Medicolegal consequences for the entire care team
The reporting discipline
One of the most important phrases in radiology is not a diagnosis—it’s restraint:
“Retained surgical material (gossypiboma) cannot be excluded.”
Not because we are uncertain…
But because we are responsible.
We describe what we see.
We suggest what is possible.
We let surgery confirm.
Take-home message for sonographers:
If a post-operative patient is not improving clinically, and imaging shows an unexplained echogenic mass with inflammatory changes…
Do not rush past it.
Slow down.
Re-evaluate.
And always ask:
“What if this is something that should not be inside the body?”
Because sometimes… it shouldn’t be.
