Presentation
Difficult hysterectomy with intra-operative bleeding. Dropped Hb post-operatively. Re-look laparotomy to control bleeding. Now septic. CT to look for collections.
Patient Data
There is a collection containing fluid with enhancing margins immediately superior to the vaginal apex. This contains a couple of bubbles of gas. Immediately superior and anterior to this collection is another one, containing more gas, admixed with soft tissue density material. This has a curved shape, concave anteriorly.
Case Discussion
The collection containing gas admixed with soft tissue was misinterpreted as being a contained fecal leak from perforated bowel, particularly in light of the complicated surgery and current sepsis. However, it is very well defined and lies immediately adjacent to the ligated vaginal stump where there was copious bleeding at surgery. There is no enhancing margin as would be expected for an abscess. This is surgical hemostatic material (oxidised cellulose), confirmed in the operative notes. It is important to be aware of this appearance such that abscesses and collections are not "over-called".
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