Surgical haemostatic material
Surgical haemostatic material is used to control bleeding intraoperatively and is hence frequently voluntarily left in the operative bed, not to be confused with a gossypiboma which is foreign material left by mistake. It can mimic an abscess on imaging studies. Various types are available, the most common type being composed of oxidised regenerated cellulose.
Oxidized regenerated cellulose or Surgicel® (Ethicon, Johnson & Johnson) 7 is a bioabsorbable sterile knitted fabric prepared by the controlled oxidation of regenerated cellulose.
The mechanism of action whereby Surgicel® accelerates clotting is not completely understood, the effect appears to be physical rather than an alteration to the physiological clotting mechanism.
Surgicel® combines with blood into a brownish gelatinous mass which aids in the formation of a clot, as it is bioabsorbable it can be left in the surgical bed with almost no local tissue reaction. Retained Surgicel® is normally reabsorbed within 7-14 days.
Differentiating haemostatic material from abscess
The most important factor is accurate clinical information on the use of surgical haemostatic material. If in doubt, discuss with the operating surgeon who should be able to advise whether surgical haemostatic material was used.
There are a number of appearances that can help to differentiate between surgical haemostatic material and abscess 6:
- gas pockets are packed tightly, are not discrete, and are lined up in a linear fashion
- air-fluid levels, commonly seen in abscess are usually not seen with surgical haemostatic material
- rim enhancement is generally not seen around surgical haemostatic material
- surgical haemostatic material ‘collections’ tend to be organised in geometric shapes
Oxidised cellulose is seen as an echogenic mass with posterior reverberation artifact from the gas, mimicking a gas-containing abscess 4. There may be surrounding free fluid.
A well-defined "collection" comprised of mixed gas and soft tissue is seen, often surrounded by free fluid and adjacent to other collections. An enhancing margin typical of abscesses is usually not present.
Be cautious about labelling well-defined clusters of admixed gas and soft tissue without definable marginal enhancement as abscesses. Check with the operating surgeon whether surgical haemostatic material was used.
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- 2. Arnold AC, Sodickson A. Postoperative Surgicel mimicking abscesses following cholecystectomy and liver biopsy. Emergency radiology. 15 (3): 183-5. doi:10.1007/s10140-007-0665-2 - Pubmed
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- 4. Melamed JW, Paulson EK, Kliewer MA. Sonographic appearance of oxidized cellulose (Surgicel): pitfall in the diagnosis of postoperative abscess. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 14 (1): 27-30. Pubmed
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- 7. Ethicon Inc. Johnson & Johnson. Somerville, New Jersey. Available at: http://www.ethicon.com/healthcare-professionals/products/biosurgery/surgicel-family-of-absorbable-hemostats/surgicel-original-absorbable-hemostat