Introduction and importance:Retained surgical item is a known incidental surgical complication that is a mass of a sponge. This cotton matrix is left behind in the body cavity after surgical procedures. It is an incidental, rare medical error.Case presentation:Here, the authors present a case of a 30-year-old woman who had undergone a cesarean section 2 months ago and presented with the cardinal symptoms of small bowel obstruction. A computerized abdominal tomography (CT) scan showed a well-defined tubular hyperdense structure adherent to the anterior abdominal wall that exerts a mass effect on the adjacent small bowel loops. Following the computerized abdominal tomography results, an exploratory laparotomy resection and anastomosis of a small segment of the ileum were performed. The postoperative period was uneventful, and the patient has remained disease-free to date.Clinical discussion:Because it is not anticipated, and its clinical manifestations are variable, it is frequently misdiagnosed, and often unnecessary radical surgical procedures are performed.Conclusion:It should be considered in the differential diagnosis of any postoperative case with an unresolved or unusual presentation.