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A 63-year-old woman presented with a 1-year history of vague pelvic and back pain. She had undergone laparoscopic surgery of the fallopian tubes 27 years earlier owing to infertility. Computed tomography of the abdomen showed an 8-cm pelvic mass (Panel A). Because of concern about ovarian carcinoma, she underwent an exploratory laparoscopy, which revealed extensive adhesions of the lower abdomen and a yellow, dense mass involving the entire pouch of Douglas (Panel B). Attempts to dissect the mass led to its rupture, revealing contents that were suggestive of a dermoid cyst. However, on aspiration of the contents, an old swab was identified and removed. The term for a left-behind surgical sponge is gossypiboma, derived from the Latin gossypium (cotton) and the Swahili boma (place of concealment). The patient had an uneventful recovery and was discharged 2 days later.
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