Retained surgical instrument (scalpel blade)
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Patient had surgery 3 and 1/2 months ago (right hemicolectomy with ileostomy, cholecystectomy) with adjuvant chemotherapy for right colonic carcinoma. complaining of intermittent abdominal pain in the left iliac fossa.
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The coronal and sagittal reconstructed images reveal an intraperitoneal metallic foreign body in the left iliac fossa anterior to the psoas muscle and posterior to the sigmoid colon. On 3D volume rendering, this foreign body corresponds to a surgical instrument (scalpel blade) accidentally left in the abdomen during the previous surgery.
The presence of an intra-abdominal foreign body left after surgery may cause a medico-legal problem between surgeon and patient especially if there is a complication.
A CT had been previously performed for this patient after the surgical procedure. Although the foreign body was visible it had not been reported by the radiologist as it was considered to be a surgical artefact from the anastomosis suture.
Had an abdominal x-ray been performed the diagnosis would have been immediately obvious, although generally plain films have limited utility in the setting of abdominal pain.
This case shows us the importance of 3D reconstruction in the analysis of postoperative intra-abdominal metallic foreign bodies since it is basically assumed that metallic clips are often used. Also in CT evaluation of post-operative patients, one must take notice of all "Surgical never events" including metallic or other retained foreign objects.
Additional Contributors: Z. Boudiaf M.D, R. Bouguelaa M.D