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Objective: To report the guideline for diagnosis, problem, obstruction, care and prevention of gossypiboma in patients.
Material and methods: The 58 years-old-male patient is found large complex renal cyst in the right kidney accidentally from the physical examination without abnormal condition. The result of computed tomography found the large cystic mass with internal hyperdensity area at upper pole of right kidney which is complex cyst that categorized in Bosniack category III with 50% of chance for cystic renal cell carcinoma (cystic RCC). Then the patient decided to be operated the transabdominal right radical nephrectomy and found that there was severe perinephric adhesion with large cystic tumor next to the upper pole of right kidney that contained the thick capsule. Once opened the specimen, found that it was surgical gauze merge with purulent fluid corresponding to the history that he had been operated to take the renal stone away 15 years ago.
Results: The patient was pararenal gossypiboma that represented by renal complicated cyst that has no report in the literature reviews. The most of them reported on pararenal or intrarenal solid tumor (pseudotumor). After treatment, the patient had no complication and discharged within 1 week.
Conclusion: Gossypiboma in patient is not commonly found but result of severe complication. The patient with kidney operation history, if renal complex cyst or pseudotumor found, it should realize gossypiboma as differential diagnosis even there is no abnormalcondition. The key preventions include risk awareness, surgical gauze count that should be contend carefully along with the record and communication within the team and also using of gauze with radiopaque marker.
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