Peer Review Report For: Case Report: A Painful Twist of Fate Due to Intra-abdominal Textiloma [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]

Introduction Textiloma refers to a retained surgical textile material within the body after surgery. It is a rare but serious iatrogenic complication that may remain asymptomatic for years. Case Presentation We report a case of a 38-year-old woman with a history of open ovarian cystectomy 15 years earlier, presenting with persistent abdominal pain. Imaging revealed a complex pelvic mass with abscess formation and enteric fistula. Despite interventional drainage and antibiotic therapy, the patient developed signs of sepsis. Endoscopic evaluation revealed a retained surgical textile in the rectum, which was extracted. The patient subsequently developed generalized peritonitis and underwent emergency laparotomy revealing two retained textilomas and multiple intestinal perforations. Despite aggressive surgical intervention, the patient succumbed to septic shock on postoperative day one. Conclusion Textiloma should be considered in patients with atypical abdominal masses and previous surgical history. Preventive strategies and early recognition are critical to avoid fatal outcomes.