Background and aims: The objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [ retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication. Methods: Data for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted. Results: In all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases. Conclusion: RSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.